Bullous Pemphigoid Treatment & Management

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

As in other autoimmune bullous diseases, the goal of therapy is to decrease blister formation, to promote healing of blisters and erosions, and to determine the minimal dose of medication necessary to control the disease process. Therapy must be individualized for each patient, keeping in mind preexisting conditions and other patient-specific factors.



Treatment of patients with bullous pemphigoid requires coordination of care between the dermatologist and the patient's primary care provider. Patients with oral disease may require an otolaryngologist and/or a dentist for evaluation and care. An ophthalmologist should evaluate patients with suspected ocular involvement and those requiring prolonged high-dose steroids.



The lesions may flare in patients with oral disease after eating hard and crunchy foods, such as chips, raw fruits, and vegetables.

For patients treated with systemic corticosteroid for longer than 1 month, a combined supplement of calcium and vitamin D should be instituted to prevent osteoporosis. The dosage and the frequency are stated in the recommendations established by the American College of Rheumatology Task Force in 1996. [64]

In addition to calcium and vitamin D supplementation, patients on long-term treatment with systemic corticosteroids should be taking bisphosphonate, a specific inhibitor for osteoclast-mediated bone resorption (eg, alendronate).



Patients should be instructed to avoid direct physical trauma to their skin surfaces. For example, localized bullous pemphigoid has rarely been described peristomally.



Secondary infection may occur because of the presence of multiple erosions and immunosuppressants used to control the disease. These infections may be either systemic or localized to the skin. Cutaneous infection increases the risk of scarring and delays wound healing.

Malignancies due to immunosuppressants have been reported. Case-control series in patients with bullous pemphigoid have failed to detect an increased incidence of malignancy in patients with bullous pemphigoid when compared with age- and sex-matched controls

Bone marrow suppression may occur in patients receiving immunosuppressants.

Growth restriction may occur in children receiving systemic corticosteroids and immunosuppressants. Adrenal insufficiency may occur following prolonged use of glucocorticoids. Osteoporosis and bone fractures may result following the use of systemic corticosteroids. Associated neurodegenerative disease may be antibody-mediated. [65]

There may be a higher incidence of squamous carcinoma and lymphoma in patients with pemphigoid. [66]