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BP Treatment Cessation — SCE Dermatology MCQ

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ModerateBlistering DiseasesBP Treatment CessationSCE Dermatology

A 50-year-old woman with BP has been treated successfully with Clobetasol propionate. After 12 months of gradual tapering, she has had no new blisters for 6 months. Her anti-BP180 titre has normalised. Can treatment be stopped?

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Correct answer: C — Yes — treatment cessation can be attempted when disease is in clinical and serological remission (no new blisters + normalised autoantibody titres); gradual withdrawal with monitoring is recommended

In bullous pemphigoid, treatment discontinuation can be attempted after sustained clinical remission (no new blisters for several months) combined with serological remission (normalised anti-BP180 ELISA titres). The combination of clinical and serological remission predicts successful drug withdrawal better than either alone. Gradual tapering over months with clinical monitoring for relapse is recommended. If anti-BP180 titres rise or new blisters appear during tapering, the dose should be increased. Some patients achieve durable remission off treatment; others relapse and require retreatment. The natural history of BP varies — median disease duration is 3-6 years, with approximately 30% achieving long-term remission.

Reference: BAD 2012 BP Guidelines; BJD