[Treatment of bullous pemphigoid by plasma exchange and prednisolone]

Between March, 1983 and March 1984, 12 previously untreated patients (7 men, 5 women) with biopsy proven active bullous pemphigoid entered this open study. Their initial therapy associated oral prednisolone 0.5 mg/kg in divided daily doses with 4 large volume plasma exchanges (one and half the theoretical plasma volume) over 2 weeks. The disease was considered under control when new blisters and pruritus were absent for 2 consecutive weeks. This initial treatment was well tolerated by these elderly patients (mean age 80 +/- 9 years), with no death and no major complication. Eight patients were controlled within 29 +/- 4 days. During progressive decrease of steroid dosage 5 of these 8 patients remained well (mean follow-up 7 months), 2 relapsed and one died of marasmus. Among the 4 patients who were not controlled, 3 needed only a slight increase in prednisolone doses (0.75 mg/kg/d) and 1 required up to 1 mg/kg/d and 4 additional plasma exchanges. This study suggests that a combined treatment with moderate doses of prednisolone and 4 large volume plasma exchanges is well tolerated and highly effective in bullous pemphigoid.