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Therapeutic Approach

Bullous pemphigoid is an autoimmune, subepidermal, mucocutaneous, blistering disease that typically, but not exclusively, affects the elderly population, aged 65 years and older. Involvement consists of urticarial plaques and tense, fluid-filled blisters which can be localized to one body area or generalized across several. First-line therapy often consists of topical corticosteroids for mild localized disease and/or systemic glucocorticoids combined with immunosuppressive medications, IVIg, or biologics for moderate to severe disease. Therapeutics are not without adverse events and should be guided by the severity of disease (erosions/bullae/urticaria/erythema on body areas), risk of adverse events, and relevant patient comorbidities. See Table 40-1.

Table 40-1Bullous Pemphigoid Treatment Table

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