Causes of Bullous Pemphigoid
Causes of bullous pemphigoid stem from an autoimmune malfunction, though the exact trigger is not always clear. The most well-established causes of bullous pemphigoid include age-related immune system changes, certain medications, underlying illnesses, and skin trauma.
In this condition, the immune system produces antibodies against proteins in the basement membrane zone of the skin. Specifically, it targets two proteins — BP180 and BP230 — which help bind the epidermis to the dermis. When these proteins are attacked, it causes inflammation and fluid accumulation between the skin layers, leading to blister formation.
Age is the most significant risk factor. Bullous pemphigoid mainly affects individuals over the age of 60 and becomes more common with advancing age. This suggests that immune dysregulation in older adults plays a key role.
Certain medications have been linked to triggering bullous pemphigoid in some people. These include diuretics (like furosemide), antibiotics (like penicillin), and drugs used to treat diabetes (such as DPP-4 inhibitors). Reactions can occur weeks or even months after starting the medication.
Causes of bullous pemphigoid
Skin trauma — such as surgery, burns, radiation therapy, or chronic wounds — can also precede the onset of bullous pemphigoid in affected individuals. Physical stress to the skin may provoke an immune response that targets the skin’s structural proteins.
There is also evidence that some neurological diseases like Parkinson’s disease, multiple sclerosis, and dementia are associated with a higher risk of developing bullous pemphigoid. The exact link is not fully understood but may relate to overlapping immune system dysfunction.
Genetic predisposition appears to play a minor role, and bullous pemphigoid is generally not inherited. Environmental triggers, infections, and seasonal changes have also been proposed, but more research is needed to confirm their influence.
Understanding the causes of bullous pemphigoid helps guide prevention strategies, especially in high-risk individuals — such as avoiding known drug triggers and monitoring for early symptoms.
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