dermatologic disorders
Bullous Pemphigoid
Treatment of Bullous Pemphigoid
Corticosteroids, topical or oral Anti-inflammatory drugs Immunosuppressant drugs or biologics High-potency topical corticosteroids (eg,clobetasol0.05% cream) should be used for localized disease and may reduce the required dose of systemic drugs. Patients with generalized disease often require systemic treatment withprednisone60 to 80 mg orally once a day, which can be tapered to a maintenance level of≤10 to 20 mg/day after several weeks. Most patients achieve remission after 2 to 10 months, but treatment may need to continue for several years before the disease process remits enough to allow discontinuation. If long-term therapy is necessary, a new blister every few weeks does not require increasing theprednisonedose. Bullous pemphigoid occasionally responds to the anti-inflammatory activity of certain drugs, such as the combination oftetracyclineorminocyclineand nicotinamide. Other treatment options include monotherapy withdapsone, sulfapyridine, orerythromycin. IV immune globulin has been used occasionally. For patients with generalized and recalcitrant disease, and sometimes to decrease corticosteroid dose in chronic disease, immunosuppressants such asmethotrexate,azathioprine,cyclophosphamide,mycophenolatemofetil, andcyclosporinemay be used. Among the biologics,rituximabandomalizumabmay be used. 