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Bullous Pemphigoid — SCE Dermatology MCQ

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ModerateBlistering DiseasesBullous PemphigoidSCE Dermatology

A 60-year-old woman with bullous pemphigoid has been treated with whole-body Clobetasol propionate 30 g/day as per the Joly protocol. Her disease is now controlled (no new blisters for 15 days). What is the next step according to this protocol?

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Correct answer: E — Continue Clobetasol at the same dose for 15 more days then begin gradual tapering over 4-12 months

The Joly/French protocol for BP management with whole-body super-potent topical corticosteroid (Clobetasol propionate) involves: initial phase at 20-40 g/day applied once daily to entire body (including uninvolved skin, sparing face) until disease control (no new blisters/erosions for 15 consecutive days), then continuation of the same dose for 15 additional days, followed by gradual tapering over 4-12 months. The pivotal French RCT demonstrated superpotent topical steroids were as effective as oral Prednisolone with significantly fewer serious adverse events and lower mortality in elderly patients. This evidence underpins the current preference for topical over systemic corticosteroids in BP.

Reference: BAD 2012 BP Guidelines; Joly 2002 French BP Trial