Bullous Pemphigoid — SCE Dermatology MCQ

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ModerateBlistering DiseasesBullous PemphigoidSCE Dermatology

A 65-year-old woman with bullous pemphigoid has been started on Doxycycline 200 mg daily as first-line treatment (per BLISTER trial evidence). At week 6, she has incomplete disease control with continued new blisters. What is the recommended next step?

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Correct answer: D — Add potent topical Clobetasol propionate

The BLISTER trial demonstrated that whole-body superpotent topical corticosteroid (Clobetasol propionate 0.05%) is highly effective for bullous pemphigoid — indeed, it was the standard comparator in the French BP trial showing superiority of potent topical steroids over oral steroids. For patients on Doxycycline with incomplete response, adding potent whole-body topical Clobetasol propionate is the recommended escalation before considering systemic corticosteroids. The 2024 BAD reaudit confirmed increasing Doxycycline use as first-line and combination with topical Clobetasol as a steroid-sparing approach in elderly patients with significant comorbidities.

Reference: BAD 2012 BP Guidelines; BLISTER Trial 2017; BAD 2024 Reaudit