2.If there are large blisters on the skin but not in the oral cavity, consider the possibility of bullous pemphigoid in older patients. It differs than pemphigus vulgaris in that it usually affects persons between the ages of 60 and 80. It differs than pemphigus vulgaris also by the lack of oral lesions. It is however, similar to pemphigus vulgaris in that it is mediated by the action of immunoglobulin G also. It is thought to deposit in the skin basement membrane. This causes the basal cells to detach from the dermal layer of the skin. This in turn leads to the formation of subcutaneous vesicles which contain predominantly white blood cells.
3.Look for erythematous vesicles in younger subjects. This disease is common between the ages of 20 to 40 years. This disorder has strong association with gluten induced enteritis or celiac disease. In spite of the apparent link between the two disorders removal of gluten from the diet does not improve the dermatitis. It is mediated by the action of immunoglobulin A instead of immunoglobulin G. Clinically speaking, this is a chronic disease with relapses and remission. The treatment to this condition is also by suppression of the overactive immune system with steroids.