Novel Wound Care Practices in Bullous Pemphigoid: A Systematic Review

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease. Yet, despite its significant impact on patient morbidity and quality of life, the role of wound care in disease management is not well documented in the literature and there is an overall lack of consensus regarding optimal wound care strategies. This systematic review and meta-analysis aimed to critically appraise the available evidence on wound practices in bullous pemphigoid with the goal of identifying interventions that enhance clinical outcomes, including healing time, infection control, and pain management. A comprehensive literature review was performed on the National Institute of Health (Pubmed), Embase, and Web of Science. Two independent reviewers conducted the screening, with discrepancies resolved by consensus. Of 1087 total articles extracted, five articles met the inclusion criteria. Among them, two studies were eliminated due to their incomplete or terminated status, and three articles were included in this review, assessing ozone liquid dressing (OLD), recombinant human type XVII collagen (RHCXVII), and berberine-based dressings. OLD was associated with faster wound healing, decreased infection rates, and improved pain control. Application of RHCXVII hydrogel led to faster healing, blister regression time, and greater patient satisfaction. A single case of berberine 'stamp therapy' showed symptomatic benefit as a topical adjunct in bullous pemphigoid wound care. These findings highlight the emerging, yet underrepresented, role of wound care in bullous pemphigoid, as well as the need for large-scale, multicentre randomised controlled trials to critically evaluate wound care modalities in its management with the goal of constructing standardized guidelines.