Is Bullous Pemphigoid Contagious? What Patients Should Know

No, uncomplicated bullous pemphigoid is not contagious. You cannot pass the condition itself to your spouse, your grandchildren, or anyone else. Because the condition causes visible blisters on the skin, it is entirely understandable to worry that you might have an infection that could spread to others. However, bullous pemphigoid is an autoimmune condition, not a bacterial or viral infection ^[1].

While the bullous pemphigoid itself is not contagious, it is important to know that the open wounds left by blisters can sometimes become infected by common outside germs, which can be transmissible.

Understanding the Autoimmune Connection

To understand why bullous pemphigoid isn’t contagious, it helps to know how it starts. In a healthy immune system, special proteins called antibodies are produced to fight off outside invaders like viruses and bacteria. If you have bullous pemphigoid, your immune system produces autoantibodies — immune proteins that mistakenly attack your body’s own healthy tissues ^[1]. While doctors do not always completely understand why this happens in every person, they know it is an internal process, not a germ you caught from someone else.

Specifically, these autoantibodies attack two proteins in your skin known as BP180 and BP230 ^[2]. These proteins act like tiny anchors that hold the epidermis (the top layer of your skin) to the layers underneath. When your immune system attacks these anchors, it triggers inflammation (swelling and irritation) and causes the skin layers to separate, filling with fluid and forming a blister ^[3]. Because this process is driven by an internal immune misfire, there is no transmissible microorganism causing the disease ^[1].

Safe Contact in Daily Life

You generally do not need to isolate yourself from your family or change how you interact with them. As long as your blisters are uninfected, it is safe to:

• Hug, hold hands with, or touch your loved ones
• Share a bed or bedroom with your spouse
• Wash your clothing, bedding, and towels in the same laundry load as your family’s

While physical affection is safe, your skin is fragile. You may need to adapt how you hug or play with grandchildren to avoid rubbing, pressure, or friction on painful areas.

Fluid from a clear, uninfected blister is a result of your body’s natural inflammatory response and does not contain contagious bacteria or viruses ^[3]. However, if the fluid becomes cloudy, yellow, or foul-smelling, this may indicate a new infection.

A Note on Secondary Infections

While bullous pemphigoid itself is not transmissible, the open sores left behind when blisters break compromise your skin barrier. This provides an entry point for everyday bacteria. When a new outside germ infects the open wound, this is known as a secondary infection.

Secondary infections are common in people with bullous pemphigoid, particularly because many of the medications used to treat the condition suppress the immune system ^[4]. If a blister develops a secondary bacterial infection, the drainage from that infected wound can contain bacteria that may spread through contact or shared towels. Proper wound care is an important part of managing your condition ^[5].

What You Should Do At Home

To protect yourself and manage the risk of secondary infections, you should:

• Practice good hand hygiene: Wash your hands thoroughly before and after changing your dressings.
• Keep lesions covered: Use the specific non-stick dressings recommended by your clinician ^[5].
• Do not pop blisters: Unless explicitly instructed by your doctor, leave blisters intact to protect the skin underneath.
• Take precautions if infected: If you suspect a blister is infected, do not share towels or washcloths, keep the wound covered, and avoid direct contact with the drainage until you see a clinician.

When to Seek Immediate Medical Advice
Contact your care team promptly if you experience warning signs of a secondary infection, which include:

• Fluid draining from a blister that is cloudy, yellow, or foul-smelling
• Rapidly spreading redness, warmth, or red streaks radiating from a blister
• A sudden increase in pain or swelling
• Fever, chills, or feeling unusually unwell