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Bullous pemphigoid — ABIM Board MCQ

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HardDermatologyBullous pemphigoidABIM Board

A frail 82-year-old has biopsy-confirmed bullous pemphigoid involving 12% of body surface area without mucosal disease. A caregiver can apply treatment twice daily, and there is no secondary infection. Which initial regimen best minimizes systemic toxicity?

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Correct answer: E — Use a superpotent topical corticosteroid regimen with planned taper

The best answer is “Use a superpotent topical corticosteroid regimen with planned taper”. For localized or moderate bullous pemphigoid in a patient for whom application is feasible, a superpotent topical corticosteroid can control disease while avoiding much of the mortality and metabolic toxicity of systemic glucocorticoids. Doxycycline can be considered in selected cases, but severe progression may require stronger control. Rituximab is reserved for refractory disease, and acyclovir does not treat this autoimmune blistering disorder.

Reference: Cochrane review: interventions for bullous pemphigoid: https://pmc.ncbi.nlm.nih.gov/articles/PMC10421473/