High-dose methylprednisolone in the treatment of bullous pemphigoid

Eight hospitalized patients with active bullous pemphigoid were treated with high-dose intravenous methylprednisolone pulse therapy followed by moderate maintenance doses of oral prednisone. Blistering decreased within 24 hours of the first pulse dose in seven of the eight patients. When blistering recurred, it was less severe than it had been before pulse therapy was given. Our earlier experience and data from the literature show that most patients with bullous pemphigoid will respond to oral corticosteroids and/or immunosuppressive treatment. Pulse therapy has a role in the treatment of bullous pemphigoid, and a mechanism of action is proposed.