About Bullous Diseases

Bullous diseases are a group of skin disorders characterized by the formation of fluid-filled blisters known as bullae. The bullae can be painful, itchy or uncomfortable, and can significantly interfere with an individuals’s ability to function and engage in daily activities.

When a bullous disease affects the lungs, the bullae may interfere with the breathing passages. This can lead to emphysema and if severe enough, may result in the need for surgery. Unfortunately even if treated, the damage already done to the lungs usually cannot be reversed.

Types of Bullous Diseases

Bullous Pemphigoid

An autoimmune skin disease causing the formation of bullae between the epidermis (outermost skin layer) and the dermis (skin layer below the epidermis). Bullae can form on any part of the skin but are most commonly found in the inner parts of the arms and legs as well as the extremities.This condition is most commonly found in individuals over the age of 70.

Linear IgA Bullous Dermatosis (LABD)

Is a rare autoimmune skin disease that is characterized by the formation bullae that visually appear similar to bullae created by other bullous diseases such as Bullous Pemphigoid. This condition can be drug-induced by particular drugs such as Vancomycin; however, many cases of LABD are idiopathic (meaning the cause is unknown).

Epidermolysis Bullosa (EB)

Is a group of connective tissue diseases that causes the skin to become extremely fragile resulting in the development of blisters. These diseases are typically inherited and the symptoms usually surface during childhood. There is no cure but treatment may help alleviate the symptoms.

Dermatitis Herpetiformis (DH) or Duhring Disease

Is a chronic autoimmune skin disease that causes the groups of blisters that resemble herpes lesions to form. However, DH and the resulting blisters have no relation to herpes at all despite the condition’s name. The blisters of DH are notorious for being extremely itchy. There is a known connection between DH and celiac disease but the exact the relationship between the two is not fully understood.

Stevens-Johnson Syndrome (SJS)

Is a rare skin condition that is typically triggered by medication or infections (in some instances, cancer). The condition is characterized by the death of cells that causes the epidermis to separate from the dermis, which can sometimes be lethal. This induces several symptoms such as fever, fatigue, and the formation of blisters and lesions on the skin as well as the mucous membranes.

Pemphigus

Is a group of autoimmune skin diseases that causes blisters to form on the skin and mucous membranes. These diseases induce autoantibodies to attack desmogleins (proteins that function like glue to hold epidermal cells together) and as a result, cause blisters to develop. There are four types of pemphigus that each differs in severity and cause.

Pemphigus Foliaceus (PF) – is characterized by crusty sores and caused by the autoantibodies attacking Desmoglein 1 (protein found on the top layer of skin). PF tends to be the least severe type of pemphigus.

Pemphigus Vulgaris (PV) – is the most common type of pemphigus that is characterized by sores originating from the mouth. It is caused by autoantibodies attacking Desmoglein 3 (protein found between specific cells). It typically affects individuals over the age of 40 but can surface at any age.

IgA Pemphigus – is characterized by IgA autoantibodies attacking desmoglein.

Paraneoplastic pemphigus (PNP) – this type is an outcome of cancer. It is the least common type but is the most severe. It some instances, the PNP may surface before the diagnosis of the cancer. The condition may improve after the cancer is removed but that is not always the case.

Qualifying for Disability with a Bullous Disease

Bullous diseases are evaluated under part 8 Skin Disorders of the Blue Book. Section 8.03 lists the specific details for a bullous disease to qualify for Social Security Disability benefits.

8.03 Bullous Disease

Applicant must have a bullous disease with extensive skin lesions that continue for 3 months or more despite using prescribed treatment.

What does the SSA consider as “extensive skin lesions”?

The Social Security Administration states in the Blue Book that extensive skin lesions are skin lesions that affect multiple body sites and cause a severe limitation. Here are some examples of extensive skin lesions:

An applicant’s skin legions interfere with his or her joint motions as well as interfere with at least two extremities (any combination of extremities will do).

An applicant has skin lesions on the palms of his or her hands that severely interfere with his or her ability to engage in fine and gross motor movements.

An applicant has skin lesions on the soles of his or her feet, the perineum, or both inguinal areas that severely limit his or her ability to ambulate.