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Bullous Pemphigoid — SCE Dermatology MCQ

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HardBlistering DiseasesBullous PemphigoidSCE Dermatology

A 70-year-old woman with bullous pemphigoid has been treated with Doxycycline as an alternative to systemic corticosteroids. The BLISTER trial compared Doxycycline to Prednisolone for bullous pemphigoid. What was the key finding?

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Correct answer: C — Doxycycline was non-inferior to Prednisolone at 6 weeks with fewer serious adverse events

The BLISTER trial (BJD 2017) was a pragmatic RCT comparing Doxycycline 200 mg/day with Prednisolone 0.5 mg/kg/day for bullous pemphigoid. Key finding: Doxycycline was non-inferior to Prednisolone for short-term blister control at 6 weeks and was associated with significantly fewer serious adverse events (especially steroid-related complications) at 52 weeks. This has led to increased use of Doxycycline as initial therapy for BP in the UK, reflected in the 2024 BAD re-audit showing increased doxycycline use.

Reference: Williams HC 2017 BLISTER Trial BJD; BAD 2024 BP re-audit