Bullous Diseases - Condition and Symptoms
Bullous Diseases are named after the elevated, fluid-filled blisters called bullae that form as a symptom of these conditions. Bullous Diseases include the seven diseases described below, as well as staphylococcal scalded skin syndrome, toxic epidermal necrolysis and other conditions.
Bullous Pemphigoid is an autoimmune skin disorder in which the body attacks the lowest level of the epidermis. This condition is found in elderly patients and is characterized by chronic, itching blisters.
Linear Immunoglobulin A (IgA) disease is distinguished by linear deposits of immunoglobulin A (IgA) in the area joining the epidermis and dermis of the skin. Immunoglobulins are a group of large glycol-proteins that are secreted by plasma. In the case of this disease, clusters of burning, itching lesions form, often in between folds of skin (such as between the upper thigh and the torso). This condition occurs both in adults and children, and can be caused by certain drugs, such as vancomycin.
Epidermolysis Bullosa Acquisita is a chronic condition in which blisters and lesions spontaneously appear on otherwise healthy-looking skin, either with no apparent cause or caused by minor trauma (usually to the elbows, knees, ankles, and buttocks). This condition is usually found in adults. This condition causes both pain and scarring, and can affect hands, feet, eyes, mouth, genitals, and the inside of the throat.
Dermatitis Herpetiformis is an autoimmune reaction to gluten, which may otherwise be asymptomatic. It is characterized by clusters of raised, itching lesions similar to hives, and can be found in persons of any age.
Stevens-Johnson Syndrome is a variant of erythema multiforme bullosum which is characterized by the formation of blisters and lesions on the soles of the feet, palms of the hands, and inside the mouth.
Pemphigus Foliaceus causes blistering in the upper layers of the skin, causing crusty, scaly erosions to form on the skin. Like other Bullous Diseases, this condition causes blisters, but the blisters are so fragile they rupture rapidly. It usually occurs in middle aged people. There is a related strain of the disease called pemphigus erythematosus that causes lesions similar to those caused by cutaneous lupus erythematosus.
Pemphigus Vulgaris is an uncommon but extremely severe autoimmune condition that is potentially fatal. It is characterized by blisters that appear within the skin and by extensive erosions on apparently healthy skin and on the mucous membranes. Often, skin or mucous membranes slide off entirely, leaving painful, raw erosions which can easily become infected. Because the disease attacks the mucous membranes, it can be very hard to eat or swallow. Unlike the blisters that characterize the other Bullous Diseases discussed here, the blisters in pemphigus vulgaris do not itch. If a large portion of the body is covered with lesions, then the person often loses significant amounts of fluid and electolytes. This condition occurs mostly in middle aged or older people, and rarely in children. Before the use of systemic corticosteroids, pemphigus vulgaris was usually fatal. Even with the most current methods available, this condition responds erratically, if at all, to treatment. The disease also lasts for a prolonged period and exposes the patient to virtually inevitable adverse drug effects. Hospitalization is usually required in all but the most minor cases. Cleansing and dressing of open skin lesions is similar to treatment for burn patients.
All Bullous conditions are diagnosed by skin biopsy, sometimes with direct immunofluorescence testing. All these conditions are characterized by the presence of bullae, or blisters. These blisters are often, but not always, itchy, raised, and in clusters on, in, or underneath the skin. Treatment options are drug-related and include steroids, antibiotics, and/or immunosuppressants, all of which can cause side effects in the affected person.
Filing for Social Security Disability with a Bullous Disease Diagnosis
The Social Security Administration (SSA) discusses Bullous Diseases under Section 8.03 of the Blue Book. In order to meet the requirements of this listing, you must have extensive skin lesions that persist for at least three months, despite continuing prescribed treatment.
When preparing to apply for disability benefits with a disability related to a Bullous Disease, you need to gather medical documentation that describes the onset, duration, frequency of flare-ups, and prognosis of your skin condition. In addition, the SSA requires information concerning:
- the location, size, and appearance of lesions
- your history (if applicable) of exposure to toxins, allergens, or irritants, familial incidence, seasonal variation, and stress factors, and
- your ability to function outside of a highly protective environment.
The SSA will also want laboratory finding to confirm the diagnosis, and they may request a copy of all laboratory findings, such as the results of a diagnostic biopsy. In assessing your disability case, the SSA is primarily concerned with how your Bullous Disease limits you and affects your daily life, what sort of treatment you are receiving, the effectiveness of this treatment, how the treatment itself affects (or limits) you, and how long it is estimated you will need to continue receiving treatment. When you apply for disability benefits, be sure to document the extent of skin lesions, describing the areas on your body where they are found, and documenting how these lesions affect your ability to perform daily tasks. In particular, you will want to describe all skin lesions that
- interfere with the motion of your joints and that very seriously limit your use of more than one extremity,
- are found on the palms of both hands and so seriously limit your ability to do fine and gross motor movements, and/or
- are found on the soles of both feet, the perineum, or the groin area that very seriously limit your ability to walk.
Be sure to describe your symptoms in detail, including pain, itching, and other discomfort. If your symptoms are intermittent, the SSA also considers the frequency of your skin flare-ups when determining whether you have an impairment severe enough to warrant Social Security Disability benefits.
Your Bullous Disease Disability Case
If you are disabled because of a Bullous Disease that is so severe it prevents you from working, you may be entitled to Social Security Disability (SSDI) benefits. Working closely with medical professionals and a qualified Social Security disability attorney or advocate to collect and present the appropriate documentation to support your case in front of the Disability Determination Services (DDS) can help to ensure that your Bullous Disease disability claim will have the highest possible chance of success.