Thank you very much for the information provided.
The lesions are very classic of Bullous Pemphigoid. The blistering over lesions of hives are classic of Bullous Pemphigoid. I had mentioned this to before you revealed the skin biopsy report.
The stroke is not directly related to Bullous Pemphigoid but can be related to a spectrum of autoimmune diseases.
So indirectly it can be related but to Directly.
We see many cases in our clinical practice of Bullous pemphigoid in the age group of 40 to 60.
So age cannot be considered as a reason to rule out the disease.
Apart from Steroid medications there are number of non steroidal options like Mycofenolate Mofetil , Azathioprine and Biologicals like Rituximab that can also work at the root level to treat her condition. She needs to discuss the feasibility of these medications I have mentioned to control her disease.
The skin becomes hot with the hive like feature as pathology shows that there are number of eosinophils in the skin that causes the skin to become allergic / hot and hence ice packs help.
The mouth involvement can also happen due to autoimmune blistering disease like Pemphigus vulgaris . She should also do a blood work up called Desmoglein 1 and 3 antigen assay . This would give a great insight into her condition.
Is it possible to check if she has done this above report ?