Treatment of bullous pemphigoid with topical clobetasol propionate

The potent topical corticosteroid clobetasol propionate was evaluated in an open-label study for its safety and efficacy in the treatment of bullous pemphigoid. Ten patients admitted to the hospital with this diagnosis had clobetasol propionate cream applied twice daily to affected skin until all lesions were healed and for 2 weeks thereafter. Complete epithelialization was achieved in every case within 4 to 17 days of treatment. After discharge, patients received decreasingly less potent corticosteroid creams as maintenance therapy for between 5 weeks and 13 months. As of this report, 7 of the 10 patients remain in remission (range 1 to 10 months). In one patient the disease was exacerbated, and therapy with corticosteroids could not be discontinued. No local or systemic side effects were observed during the study, and plasma cortisol levels were within the normal range when measured during the early tapering-off period while patients were receiving less potent topical corticosteroids. We conclude that clobetasol propionate cream produced rapid healing of bullous lesions without adverse effects and that this treatment followed by maintenance therapy with less potent topical corticosteroids was highly effective in patients with bullous pemphigoid.