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A man in his 50s presented with a two week history of pruritic erythema and blisters on the trunk, which rapidly progressed across the body (fig 1). He had a 10 year history of hypertension treated with metoprolol, and chronic kidney disease (CKD) for which he received long term haemodialysis. His medications had not been changed recently. Physical examination showed widespread tense blisters and bullae on an erythematous base. The Nikolsky sign was negative. Direct immunofluorescence showed linear IgG deposition at the basement membrane zone, and serology was strongly positive for anti-BP180 IgG antibodies. He was diagnosed as having bullous pemphigoid.