Treatment of Bullous Pemphigoid
Treatment of bullous pemphigoid aims to control blister formation, reduce itching, and suppress the immune system’s attack on the skin. Effective treatment of bullous pemphigoid depends on the severity of the condition and the overall health of the patient.
The cornerstone of treatment is corticosteroids, which help reduce inflammation and stop blistering. For mild, localised cases, a potent topical steroid cream such as clobetasol may be sufficient. For more widespread disease, oral steroids like prednisolone are commonly prescribed.
While corticosteroids are effective, they can cause significant side effects — particularly in elderly patients — including high blood pressure, osteoporosis, and increased risk of infections. Therefore, doctors often try to minimise the steroid dose or use steroid-sparing alternatives.
Immunosuppressant medications such as azathioprine, methotrexate, or mycophenolate mofetil may be added to reduce steroid use and maintain long-term control. These drugs work by dampening the overactive immune response responsible for blister formation.
Tetracycline antibiotics like doxycycline, sometimes combined with nicotinamide (a form of vitamin B3), have shown effectiveness in controlling inflammation in milder cases, offering a less risky option for some patients.
Biologic therapies such as rituximab may be considered in severe or treatment-resistant cases. These target specific immune cells involved in antibody production and have shown promise in reducing flare-ups and steroid dependence.
Treatment of Bullous Pemphigoid
Additional treatments include antihistamines to manage itching, skin hygiene practices to prevent infection, and wound care for broken blisters. Maintaining good nutrition and hydration is also vital during flare-ups.
Close monitoring is essential to adjust medications, check for side effects, and assess healing progress. Treatment may be needed for months or even years, depending on disease activity.
Successful treatment of bullous pemphigoid requires an individualised approach, balancing symptom control with long-term safety — especially in older adults who may have other chronic health conditions.
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