Bullous pemphigoid

Abstract

Bullous pemphigoid is the most common cutaneous autoimmune blistering diseases with an estimated incidence in the United States of 24 cases per million person-years. It is a chronic disease of the elderly that can cause significant morbidity secondary to pruritus and open wounds. High potency topical corticosteroids are effective for patients with limited disease and in treating disease flares. Oral corticosteroids are the main stay of early treatment for more extensive disease because of their fast onset of action, but should not be used for long-term management at high doses because of the significant risk of potentially serious side effects. Steroidsparing agents such as azathioprine, mycophenolate mofetil and methotrexate have shown to be effective in decreasing the dose of systemic corticosteroids required. For more recalcitrant cases, IVIG and rituximab can also be considered. The choice of an appropriate treatment must also balance the risks of systemic immunosuppression in this elderly population with other medical comorbidities.