Whole body application of a potent topical corticosteroid for bullous pemphigoid

Abstract

Current standard of treatment of bullous pemphigoid (BP) is systemic oral corticosteroids (CS). However, significant iatrogenic morbidity and mortality is reported. Studies have shown that topical potent CS is safer than oral prednisolone in BP. To examine the local and systemic efficacy and adverse effects of whole body clobetasol propionate cream application in patients with mild or severe BP. Open, clinical records-based retrospective analysis of a series of mild (n = 40) and severe (n = 34) BP patients, treated with ranging doses (20-40 g/day) clobetasol propionate cream. For assessing systemic effects, we observed in selected cases eosinophil count and morning urine cortisol level. Patients with mild BP achieved in 90.0% disease control and in severe BP in 73.5%. Complete remission was achieved in mild BP in 64.1% (35.9% off therapy and 28.2% on therapy) vs. 41.2% in severe BP (5.9% off therapy and 35.3% on therapy). Local adverse effects were mainly skin atrophy (14.9%) and purpura (5.4%). Systemic adverse effects were rare (n = 3) and consisted of deep vein thrombosis, hypertrichosis and adrenocortical insufficiency. Systemic effect was witnessed by immediate drop of eosinophil count, and decrease in the morning urine cortisol in selected cases. Topical whole body application of clobetasol propionate cream as monotherapy can be effective and safe in the induction phase of treatment in mild BP and severe BP. When relapse occurs adjuvant systemic medication is mandatory. Potent CS works locally and systemically against BP, at the price of significant local and less significant systemic adverse effects.