[Management of bullous pemphigoid]

Area of Science:

• Dermatology
• Immunology
• Autoimmune Diseases

Background:

• Bullous pemphigoid is the most common autoimmune blistering skin disease in adults.
• It results from autoantibodies targeting hemidesmosomal proteins, causing subepidermal blistering.
• Patients, typically over 70, present with skin bullae and erosions, occasionally affecting mucous membranes.

Purpose of the Study:

• To address the need for effective long-term treatments for bullous pemphigoid, considering side effects and comorbidities.
• To explore treatment options for the chronically relapsing nature of the disease.
• To highlight the absence of a definitive curative treatment.

Main Methods:

• Treatment selection is guided by disease activity and mucocutaneous manifestation extent.
• High-potency topical corticosteroids are preferred for fewer side effects.
• Systemic corticosteroids are combined with immunomodulators or immunosuppressives for severe or refractory cases.

Main Results:

• Topical class IV corticosteroids are effective for milder cases.
• Systemic corticosteroids combined with agents like dapsone, doxycycline, azathioprine, mycophenolate, or methotrexate manage intense or refractory disease.
• Off-label options like rituximab and IVIg are available for refractory cases.

Conclusions:

• Treatment strategies should be tailored to individual patient needs and disease severity.
• Long-term use of immunosuppressants is recommended to minimize corticosteroid dependency.
• Current treatments aim to manage symptoms and prevent relapse, as no cure exists.