Monitoring
Bullous pemphigoid is a chronic disease characterized by spontaneous exacerbations and remissions. Patients should be followed until they are in complete remission and off any medications.
In stable patients, reduction of medication should be attempted every 1 to 2 months based on clinical rather than immunofluorescence criteria. In about 50% of cases relapse will occur at some point during the dose-reduction period, indicating that the previous dose is likely to be the minimal effective dose for that patient. Pruritus should be under good control.
Patients who are on long-term immunosuppressive drug regimens should have appropriate monitoring at recommended intervals as well. Should any complications lead to a functional impairment, the agent should be promptly withdrawn and alternative treatments considered. The duration of systemic corticosteroid treatment in bullous pemphigoid is likely to be many months and is sometimes indefinite. Gastric protection should be considered.[9] Measures aimed at minimizing loss of bone density are appropriate in postmenopausal women and men over 50 years, and in any patient at increased risk of fragility fracture, who are expected to take a daily prednisone dose of 7.5 mg or more for at least 3 months.[9]
Use of this content is subject to our disclaimer