Efficacy and tolerability of topical corticosteroid treatment in the initial phase of bullous pemphigoid: An open study of 13 cases

Abstract

Preliminary trials of treatment with topical corticosteroids in cases of bullous pemphigoid gave interesting results (good tolerability compared to systemic corticotherapy). Our open study included 13 patients aged between 59 and 92 years suffering from bullous pemphigoid. Another 4 patients with a very active form of the disease were treated with systemic corticosteroids (1 mg/kg per day prednisone equivalent as a control group. The group of 13 patients was treated with a class I topical corticosteroid (0.05% betamethasone propylene glycol diproprionate; Diprolene ointment) applied twice daily to the lesions. The amount of active ingredient applied varied, depending on the grade of activity of the disease (increasing severity from grade I to III). In the case of resistance to topical corticotherapy (new bullae on the 15th day), mixed treatment was started (topical corticosteroid with systemic steroids at 0.5 mg/kg per day of prednisone equivalent), allowing a reduction in systemic corticotherapy. Both the clinical efficacy and the biological tolerance were monitored. Of the 13 patients treated topically, we found that of 6 with grade I disease, all were controlled; of 4 with grade II disease, 3 were controlled and 1 was resistant (effective mixed treatment); and of 3 with grade III disease, 1 was controlled and 2 were resistant (effective mixed treatment). Overall, control was achieved in about 2 weeks with no clinical side-effects being found. The effects on the pituitary-adrenal axis were lower than with systemic corticosteroids at a dose of 1 mg/kg per day of prednisone equivalent.

Key Words:

• Topical corticosteroids
• Bullous pemphigoid