From the Guidelines
For bullous pemphigoid affecting the hands and feet, the recommended initial prednisone dosage is 0.5-0.75 mg/kg per day, as suggested by the European Dermatology Forum consensus in collaboration with the European Academy of Dermatology and Venereology 1. This dosage is preferred over higher doses due to the associated higher mortality and increased side-effects.
- The initial treatment should be reduced 15 days after disease control, with a tapering schedule and dose adaptation as needed.
- In patients who do not achieve disease control within 1-3 weeks with prednisone 0.5 mg/kg, the dose can be increased to 0.75 mg/kg per day.
- Systemic treatment may be accompanied by topical therapy, such as steroids and/or other measures, to enhance treatment efficacy.
- It is essential to monitor for side effects, including blood glucose elevation, hypertension, osteoporosis, and increased infection risk, and consider preventive measures like calcium and vitamin D supplements to prevent bone loss.
- The treatment duration and dosage may vary depending on individual patient response and the presence of any side effects, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Treatment Options for Bullous Pemphigoid
- The standard treatment for bullous pemphigoid is oral steroids, such as prednisone 2, 3, 4, 5.
- The dosage of prednisone can vary, but starting doses greater than 0.75 mg/kg per day do not seem to give additional benefit, and lower doses may be adequate for disease control 3, 5.
- Combination treatments, such as prednisone with azathioprine or plasma exchange, may be useful in halving the corticosteroid dose required, but the effectiveness of these combinations has not been established 2, 3, 5.
- Topical corticosteroids, such as clobetasol propionate cream, may be effective and safe treatments for bullous pemphigoid, especially for patients with extensive disease 3, 4.
- Other treatments, such as doxycycline and nicotinamide plus tetracycline, may be less effective but cause less mortality than prednisolone, and need further investigation 4, 5.
Dosage of Prednisone
- The optimal dosage of prednisone for bullous pemphigoid is not established, but doses greater than 0.5mg/kg per day are associated with severe side-effects, including decreased survival 2.
- Starting doses of prednisolone greater than 0.75 mg/kg per day do not seem to give additional benefit, and lower doses may be adequate for disease control 3, 5.
- The dosage of prednisone may need to be adjusted based on the individual patient's response to treatment and the presence of any comorbidities 2, 3.
Treatment of Bullous Pemphigoid in Hands and Feet
- There is no specific evidence on the treatment of bullous pemphigoid in hands and feet, but the general treatment options for bullous pemphigoid may be applicable 2, 3, 4, 5.
- Topical corticosteroids, such as clobetasol propionate cream, may be effective and safe treatments for bullous pemphigoid in hands and feet, especially for patients with extensive disease 3, 4.