Treatment of Bullous Pemphigoid with Multiple Relapses During Corticosteroid Tapering

Patients with bullous pemphigoid who relapse repeatedly as topical or systemic corticosteroid doses are reduced present a distinct clinical challenge. Several therapeutic options are discussed for this scenario, going beyond corticosteroid adjustment alone.

Clinical Scenario

Bullous pemphigoid with multiple relapses occurring during tapering of topical or systemic corticosteroid doses. Several therapeutic options can be discussed in this patient population.

Treatment Approach

The protocol addresses the addition of a conventional immunosuppressive agent — where there are no contraindications — to support disease control during corticosteroid reduction. Alternative agents are also considered for patients with poor general condition or when immunosuppressive drugs are not suitable.

Specific agent selection, criteria for each option, and the full clinical algorithm are detailed in the complete structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

Several therapeutic options can be discussed in patients who have multiple relapses during tapering of topical or systemic CS doses.

The addition of a conventional immunosuppressive drug may be recommended in the absence of contraindications, in particular methotrexate (5 to 12.5 mg weekly), mycophenolate mofetil (1 to 3 g daily) or azathioprine (1 to 3 mg/kg daily according to TPMT activity) (4.73 ± 0.83), although the level of evidence is lower for the latter drug.

In patients with poor general condition and/or in those with contraindications to immunosuppressive drugs, doxycycline (200 mg daily), dapsone (1 mg to 1.5 mg/kg daily) or omalizumab may also be considered (4.53 ± 0.90).

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