Is Local Therapy for Bullous Pemphigoid Really Lower-Dose Systemic Therapy?

Bullous pemphigoid, the most common autoimmune blistering disease, affects elderly patients, who often have comorbid conditions. Traditional first-line therapy is systemic corticosteroids. French investigators conducted a randomized, multicenter, nonblinded trial of oral prednisone versus topical clobetasol propionate cream. They classified patients as having severe or moderate disease and randomized them to receive either clobetasol cream (40 g/day) or oral prednisone (0.5 mg/kg/day for moderate disease; 1 mg/kg/day for severe). Three endpoints were used to measure results: number of patients alive 1 year after diagnosis, number with controlled disease 3 weeks after initiation of therapy, and number with severe complications potentially re…