Optimizing Local Treatment in Pemphigus and Pemphigoid: Current Evidence and Unmet Needs

Area of Science:

• Dermatology
• Wound Healing
• Autoimmune Diseases

Background:

• Autoimmune blistering diseases (AIBDs), including pemphigus vulgaris (PV) and bullous pemphigoid (BP), cause painful erosions and chronic wounds, severely impacting quality of life.
• Systemic therapies are standard, but optimal local management strategies, including wound care and topical treatments, are not well-defined.

Purpose of the Study:

• To review and synthesize current evidence on topical treatments and wound care strategies for AIBDs.
• To focus on their role in disease control, infection prevention, and healing enhancement.

Main Methods:

• A narrative literature review was conducted.
• Searched PubMed-indexed articles and guidelines on topical corticosteroids, calcineurin inhibitors, antiseptics, antibiotics, and wound dressings for PV and BP management.

Main Results:

• Topical corticosteroids (e.g., clobetasol propionate) are first-line for BP and adjunctive for PV.
• Topical calcineurin inhibitors show potential as steroid-sparing agents; evidence is limited.
• Antiseptics and advanced dressings show promise but require further investigation; topical antibiotics are for secondary infections.

Conclusions:

• Topical therapies and wound care are crucial but understudied and lack standardization in AIBD management.
• Evidence supports corticosteroids, while antiseptics and advanced dressings need more research.
• Well-designed clinical trials are essential to establish evidence-based guidelines.