Abstract
Bullous pemphigoid (BP) is the commonest subtype of autoimmune blistering disease in most countries of the world. It occurs most frequently in elderly patients and is characterised clinically by large, tense blisters in the skin preceded by urticarial plaques and pruritus. Immunopathologically, it is characterised by autoantibodies directed against the 180 kD antigen (BP180) and the 230 kD antigen (BP230). New knowledge regarding BP is being continually uncovered. This article reviews the recent advances in BP, including newer diagnostic tests, standardised outcome measures and emerging therapeutic options, as well as the evidence supporting their use.
Highlights
Bullous pemphigoid (BP) is the commonest subtype of autoimmune blistering disease (AIBD), a rare but potentially fatal group of skin diseases
It is characterised by subepidermal autoantibodies directed against the 180 kD antigen (BP180) and the 230 kD antigen (BP230), two components of adhesion complexes promoting dermo-epidermal cohesion[5]
This article reviews the recent advances in BP, including diagnostic techniques, outcome measures and therapeutic options, as well as the evidence supporting their use
Summary
Bullous pemphigoid (BP) is the commonest subtype of autoimmune blistering disease (AIBD), a rare but potentially fatal group of skin diseases. Topical clobetasol has the disadvantages of poor practicality in bedridden patients, higher rates of incompliance, and poor accessibility in certain countries In these cases, oral prednisolone (0.5–1 mg/kg per day), despite its significantly worse adverse event profile, is recommended as the initial therapy instead[29,31]. Overall, introducing an immunosuppressive medication depends on several factors, including the efficacy of the firstline topical clobetasol or oral corticosteroids, the patient’s disease extent and co-morbidities, the dermatologist’s experiences, and cost considerations In this era of biological therapies, new antibody modulators, including rituximab and omalizumab, have been suggested for the treatment of BP. Future RCTs evaluating omalizumab as a potential treatment for BP may be indicated
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