What is the difference between bullous pemphigoid and cicatricial pemphigoid?

Bullous pemphigoid (IgG directed against BP180 and BP230) is a chronic autoimmune bullous disease that most commonly affects older adults. The primary lesions may be urticarial plaques or tense bullae (Fig. 10-4). Lesions occur particularly on the flexural surfaces but may be widespread. Blisters form crusts and may heal with pigmentary changes, but not scarring. The oral mucosa is sometimes affected, but lesions in this area are usually minor. Cicatricial pemphigoid (IgG or IgA directed against multiple antigens at the basement membrane zone, including BP180) is a chronic autoimmune blistering disorder associated with scarring of mucosal surfaces. It primarily affects the elderly, with some patients having blisters on the cutaneous surface. In both diseases, the diagnosis is established by correlating the clinical findings with routine histologic examination of lesional skin, direct immunofluorescence of perilesional skin, and indirect immunofluorescence or ELISA testing of serum.

Zenzo G, Marazza G, Borradori L: Bullous pemphigoid: physiopathology, clinical features and management, Adv Dermatol 23:257–288, 2007.