[BULLOUS PEMPHIGOID RESISTANT TO CORTICOSTEROIDS]

Bullous pemphigoid is the most common autoimmune bullous disease, treated with low dosage local or systemic corticosteroids. This is a case report of a 65 years-old female patient with a month long history of a bullous disease before admission to the dermatology department with a generalized bullous rash. Clinical examination and histopathology revealed bullous pemphigoid. She was treated according to the established protocol with systemic corticosteroids. The amount of prednisone was raised to 100mg per day for 8 weeks without any noticeable improvement, instead there was a worsening of her symptoms. In light of the treatment failure we carried out an adrenocorticotropic stimulation hormone test with a normal result. The patient was diagnosed as being resistant to corticosteroids and the treatment with prednisone was immediately terminated. Treatment was initiated with cyclophosphamide with an immediate improvement in her symptoms, and the patient was discharged after complete recovery. Discussion: Resistance to corticosteroids is a rare occurrence that has been reported in the literature on pulmonary and gastric disease. In dermatology, there is a single case report on atopic dermatitis that was treated locally. Awareness of the possibility will allow for a prompt diagnosis and appropriate treatment. Conclusion: We presented the case of a 65 year old female with bullous pemphigoid resistant to corticosteroids that has not been previously reported in the dermatologic literature.