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A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis
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Published on: March 14, 2025

Interventions for bullous pemphigoid.

Gudula Kirtschig1, Philippa Middleton, Cathy Bennett

  • 1Department of Dermatology, Vrije Universiteit Medisch Centrum, Po Box 7057, Amsterdam, Netherlands, 1007 MB.

The Cochrane Database of Systematic Reviews
|October 8, 2010
PubMed
Summary
This summary is machine-generated.

Potent topical steroids are effective for bullous pemphigoid (BP), with milder regimens suitable for moderate cases. Lower doses of oral prednisolone may be adequate, reducing side effects.

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Area of Science:

  • Dermatology
  • Autoimmune Diseases
  • Clinical Trials

Background:

  • Bullous pemphigoid (BP) is a prevalent autoimmune blistering disease in Western countries.
  • Current standard treatment involves oral steroids.
  • This review updates previous findings from 2005.

Purpose of the Study:

  • To systematically assess the efficacy and safety of various treatments for bullous pemphigoid.
  • To evaluate different therapeutic options based on randomized controlled trials.

Main Methods:

  • Conducted an updated search of multiple databases including Cochrane, MEDLINE, and EMBASE in August 2010.
  • Included randomized controlled trials (RCTs) of treatments for immunofluorescence-confirmed bullous pemphigoid.
  • Data extraction and study evaluation were performed independently by at least two authors.

Main Results:

  • Ten RCTs (1049 participants) with moderate to high risk of bias were included; none used placebo.
  • Plasma exchange plus prednisone showed better short-term disease control than prednisone alone in one trial.
  • Topical clobetasol demonstrated superior disease control, reduced mortality, and fewer adverse events compared to oral prednisolone in extensive/moderate BP.

Conclusions:

  • Very potent topical steroids are effective and safe for bullous pemphigoid, though extensive use may be limited by side effects.
  • Milder topical steroid regimens are safe and effective for moderate BP.
  • Lower doses of oral prednisolone (<0.75 mg/kg/day) may suffice, reducing adverse reactions; further research is needed for adjunctive therapies.