Which medications are used in the treatment of bullous pemphigoid (BP)?

Updated: Oct 14, 2020
  • Author: Lawrence S Chan, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Treatment is directed at reducing the inflammatory response and autoantibody production. Although target-specific therapy is the "Holy Grail" for immunodermatologists, non–target-specific treatments are currently used. The most commonly used medications are anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone) and immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide). Evidence suggests that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids. [5, 4, 67, 68] Omalizumab and dupilumab have been used as corticosteroid-sparing agents. [69, 70, 71]

Initial treatment with doxycycline was found to be effective and was associated with a lower incidence of adverse effects compared with prednisone. [6, 7, 8]

Proper treatments of bullous pemphigoid depend on the severity of the disease. For localized disease, topical steroids plus the systemic anti-inflammatory (tetracycline and nicotinamide) may be sufficient. Effects of monotherapy with nicotinamide are unknown. For more severe cases, systemic steroids along with immunosuppressives may be needed to control the disease. If the disease is difficult to control, consider treatment with an anti-CD20 antibody (rituximab), which is relatively specific in targeting the antibody-producing B cells. [72, 73, 74, 75, 76, 77, 78, 79, 80]


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