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Treatments and drugs
By Mayo Clinic staffThe goals of bullous pemphigoid treatment are to help the skin heal as quickly as possible and relieve itching. Your doctor will likely prescribe a combination of drugs that inhibit immune system activities that cause inflammation.
Most people experience improvement in symptoms within a few weeks, but ongoing treatment is often necessary for several years.
Corticosteroids
Corticosteroids taken as a pill (oral) are the primary treatment for bullous pemphigoid, particularly at the beginning of a treatment regimen. Some people may also be able to use a corticosteroid ointment (topical) that is applied directly to the affected skin. The side effects vary depending on whether you have oral or topical treatment.
- Oral side effects. Long-term use of oral corticosteroids can cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol, cataracts and other serious side effects.
- Topical side effects. Long-term use of topical corticosteroids can cause thinning of the skin and other skin problems.
After your skin has healed, your doctor will gradually reduce your dosage to the lowest dose possible to keep the disease under control and minimize the risk of side effects.
Immunosuppressants
Immunosuppressants are drugs that inhibit the production of your body's disease-fighting white blood cells. These drugs may be used in combination with corticosteroids to minimize the risks of corticosteroid treatment. They may also be used alone, but symptom relief may take longer to achieve.
Side effects of these drugs include an increased risk of infections. Immunosuppressants used to treat bullous pemphigoid include:
- Azathioprine (Imuran)
- Mycophenolate mofetil (CellCept)
Other anti-inflammatory drugs
Other drugs with anti-inflammatory properties that may be used alone or in combination with corticosteroids include:
- Methotrexate (Trexall), a drug often used to treat other inflammatory skin diseases and rheumatoid arthritis
- Tetracycline, an antibiotic with anti-inflammatory properties
- Nicotinamide, a byproduct of a B vitamin, taken in combination with tetracycline
- Dapsone (Aczone) and sulfapyridine, a combination of drugs with antibiotic and anti-inflammatory properties
Monitoring side effects of corticosteroids
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for potential problems. He or she may adjust your dosage and prescribe treatments to manage reactions to corticosteroid treatment.
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent osteoporosis induced by the treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking oral corticosteroids for more than three months:
- 1,000 to 1,200 milligrams (mg) of calcium supplements
- 400 to 1,000 international units (IU) of vitamin D supplements
- Bullous pemphigoid. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec10/ch112/ch112b.html. Accessed April 21, 2010.
- Goldstein BG, et al. Bullous pemphigoid and other pemphigoid disorders. http://uptodate.com/home/index.html. Accessed April 15, 2010.
- Stanley J. Bullous pemphigoid. In: Wolff K, et al., eds. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2950538. Accessed April 21, 2010.
- Kirtschig G, et al. Management of bullous pemphigoid: Recommendations for immunomodulatory treatments. American Journal of Clinical Dermatology. 2004;5:319.
- Patton T, et al. Bullous pemphigoid treatment review. Expert Opinion in Pharmacotherapy. 2006;7:2403.
- Glucocorticosteroid-induced osteoporosis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gi-osteoporosis.asp. Accessed April 15, 2010.
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