Bullous pemphigoid:therapy in patients with and without diabetes mellitus

Retrospective analysis of 34 patients with bullous pemphigoid (BP) showed 24 (70.6%) with widespread disease and 10 (29.4%) with localized disease. Initial prednisone therapy was significantly lower for patients with localized BP, mean dose of 38 mg vs 58 mg, compared with widespread disease. Fifteen of 24 (62%) patients responded; however, 9 (38%) failed to respond to moderate-dose prednisone therapy and ultimately required daily doses of 100 mg or more and/or an immunosuppressive agent. Adult-onset diabetes mellitus was present in 14 of 34 (41%) patients. Initial prednisone dose for diabetic patients with widespread BP was significantly greater, 70 mg vs 54 mg, compared with nondiabetic patients. Addition of methotrexate, 2.5 to 15 mg, every other day or twice-weekly oral administration, was effective when moderate-dose prednisone therapy failed. It is possible that insulin-dependent diabetic patients with BP should be preferentially started on immunosuppressive drugs.