What is the follow-up plan for this patient, including the timing of the next clinic visit and the focus of the assessment?

Follow-Up Plan for the Patient

For this patient, follow-up visits should be scheduled weekly to biweekly until disease control is achieved, then monthly for the next 3 months, followed by every 2 months to three times a year until treatment is stopped. 1

Timing of Follow-Up Visits

• The frequency of follow-up should be adapted to the patient's clinical condition, disease severity and evolution, treatments used, and local health practices 1
• For patients with generalized disease, follow-up should be more frequent initially (weekly to biweekly) until the condition is controlled 1
• After disease control is achieved, monthly visits for 3 months are recommended, then extending to every 2 months to three times a year 1
• The monitoring frequency should be adjusted based on the disease course and treatment response 1

Contact Method

• The patient should be provided with specific appointment dates rather than being asked to call for an appointment, as this improves compliance with follow-up (65% vs 46% compliance rate) 2
• Providing a specific clinic appointment date and time is associated with better follow-up compliance compared to having patients schedule their own appointments 2
• Consider telephone or video follow-up for stable patients, as telemedicine visits may be a convenient and efficient way to address patient needs between in-person visits 3

Focus of Next Visit

• Clinical examination should focus on:

  • Skin disease activity (checking for blisters, eczematous/urticarial-like lesions, intensity of itch) 1
  • Possible treatment-related side effects and comorbidities 1
  • The degree of skin atrophy, purpura, and skin infections 1

• Laboratory monitoring should include:

  • Blood pressure monitoring (especially if on corticosteroids) 1
  • Analysis of white blood cells, liver and kidney tests (if on immunosuppressants) 1
  • Glycemic value monitoring (if on corticosteroids) 1
  • Immune serological analyses (determination of anti-BP180 IgG by ELISA at days 0,60, and 150) as IgG autoantibody fluctuations may predict outcome 1

• Treatment assessment should include:

  • Evaluation of medication efficacy, safety, and tolerance 1
  • Assessment of patient compliance with prescribed therapy 1
  • Consideration of treatment adjustments based on clinical response 1

Documentation and Decision-Making

• Document a side-by-side comparison of findings from both visits, noting whether the patient is improved, stable, or worse 4
• Use standardized assessment tools to quantify changes in symptoms and quality of life between visits 4
• Have the patient complete a pre-visit questionnaire before follow-up visits to establish treatment goals and concerns 4
• Request that the patient bring all medications to follow-up visits for medication reconciliation 4

Special Considerations

• If the patient is on systemic corticosteroids for more than 3 months, monitor for osteoporosis and consider vitamin D and calcium supplementation 1
• For patients at risk (postmenopausal women, men aged >50 years on glucocorticoid treatment >3 months), consider bisphosphonate treatment to prevent osteoporosis 1
• If treatment fails, consider non-compliance, incorrect diagnosis, development of contact allergy to medication, or superimposed conditions (e.g., secondary candidiasis) 1
• Consider osteodensitometry and ocular examination if indicated according to the treatment regimen and the patient's age and condition 1

Treatment Discontinuation Planning

• The optimal duration of treatment has not been defined but is generally 4-12 months according to disease severity 1
• Discontinuation of treatment should be considered in patients who are free of symptoms for at least 1-6 months under minimal therapy 1
• Prior to cessation of treatment, DIF studies and/or ELISA for BP180 should be performed to assess risk of relapse 1