Updates on the Management of Autoimmune Blistering Diseases

Joanna N. Hooten, MD; Russell P. Hall 3rd, MD; Adela R. Cardones, MD

Disclosures

Skin Therapy Letter. 2014;19(5) 

In This Article

Mild to Moderate Disease

Topical Therapy

For pemphigus vulgaris (PV) patients with mild and even moderate cutaneous and oral mucosal[7] involvement, BP or EBA, a high potency topical steroid such as clobetasol 0.05% ointment or gel applied 2–3 times daily is appropriate.[5] Even in the setting of extensive disease, potent topical steroids remain an option if the patient is elderly or has numerous risk factors. Clobetasol 0.05% cream 40 g/day is at least as effective as oral prednisone in treating moderate to severe BP.[8] Some degree of systemic absorption may contribute to the efficacy of topical steroids, however, the side effect profile is still acceptable.

Antimicrobials

Antimicrobials decrease local inflammation, but have no effect on circulating autoantibodies.[9] The combination of tetracycline 2 g PO daily plus nicotinamide 1.5 g PO is a reasonable alternative for the treatment of BP in patients who are not candidates for systemic steroid therapy. In a randomized trial of 18 patients comparing prednisone with tetracycline and nicotinamide, there was no statistically significant difference in response between the two groups. In addition, 83% of patients treated with tetracycline plus nicotinamide had some improvement and 42% experienced a complete response. At long-term follow-up, a small subset of patients in the tetracycline plus nicotinamide treatment group remained in remission with tapering of the medication.[10] Several other small studies have also demonstrated variable improvement with this treatment combination.[9,11]

Colchicine

Colchicine is an anti-inflammatory drug with a mild side effect profile. High doses of colchicine have been effective in patients with classical and inflammatory EBA.[12–14] The typical dosing ranges from 0.6 mg PO BID to TID. The most frequent side effects are GI complaints, particularly diarrhea, which can limit the utility of this therapy.

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