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Related Experiment Videos

Interventions for bullous pemphigoid.

N Khumalo1, G Kirtschig, P Middleton

  • 1Dermatology Department, Groote Schuur Hospital, Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa, 7925. n_khumalo@hotmail.com

The Cochrane Database of Systematic Reviews
|July 22, 2005
PubMed
Summary
This summary is machine-generated.

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Very potent topical steroids show promise for treating bullous pemphigoid, especially in extensive disease. Lower doses of oral steroids may be sufficient, reducing adverse effects.

Area of Science:

  • Dermatology
  • Autoimmune diseases
  • Clinical trials

Background:

  • Bullous pemphigoid is the most prevalent autoimmune blistering disease in Western countries.
  • Oral corticosteroids are the established standard treatment for bullous pemphigoid.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of various treatments for bullous pemphigoid.
  • To identify optimal therapeutic strategies for managing bullous pemphigoid.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) identified through extensive database searches (up to March 2003).
  • Inclusion criteria focused on RCTs involving patients with immunofluorescence-confirmed bullous pemphigoid.
  • Data extraction was performed independently by two reviewers, with disagreements resolved through discussion.

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Main Results:

  • Seven RCTs involving 634 patients were analyzed; no placebo-controlled trials were identified.
  • Different corticosteroid formulations and doses, or the addition of azathioprine, did not demonstrate significant differences in disease control.
  • Very potent topical corticosteroids showed superior survival and disease control in extensive bullous pemphigoid compared to oral prednisone.
  • Plasma exchange combined with prednisone showed improved disease control in one study, but this was not replicated in another.

Conclusions:

  • Very potent topical steroids represent an effective and safe treatment option for bullous pemphigoid, particularly for extensive disease.
  • Lower starting doses of oral prednisolone (below 0.75 mg/kg/day) may be adequate for disease control, potentially reducing adverse reactions.
  • The benefits of adding plasma exchange or azathioprine to corticosteroid therapy remain unproven; further research is needed for combination therapies like tetracycline and nicotinamide.