Bullous diseases, including bullous pemphigoid, may present differently in patients with darker skin tones. Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Prince Adotama, assistant professor at NYU Langone’s Ronald O. Perelman Department of Dermatology. Watch as Dr. Adotama outlines what clinicians need to know about bullous pemphigoid. Learn how the treatment landscape has changed. And hear how clinicians should consider pigmentary sequelae in their treatment decisions.
Further Reading
If you want to read more about bullous pemphigoid, check out the following articles published in the Journal of Drugs in Dermatology:
Erythrodermic Bullous Pemphigoid in Skin of Color Treated With Dupilumab
ABSTRACT
Bullous pemphigoid (BP) is an autoimmune blistering disease that typically presents with pruritic, tense bullae in elderly patients.1 Several recognized presentations deviate from the classic bullous eruption, and erythrodermic BP, in particular, is thought to be a rare phenomenon. Herein, we present a case of erythrodermic BP in an African American male who initially presented with erythroderma in the absence of tense bullae. There have been no reports on erythrodermic BP in skin of color to our knowledge. The patient rapidly improved after treatment was started with dupilumab. He developed classic tense bullae seen in BP once dupilumab was discontinued.
Treatment of Bullous Pemphigoid With Dupilumab: A Case Series of 30 Patients
ABSTRACT
Bullous pemphigoid is often difficult to treat with the limited therapies available. Here, we describe clinical outcomes among 30 adults with bullous pemphigoid patients treated with dupilumab. We performed a multicenter, retrospective case series between March 2020 to August 2022. Patients received a loading dose of dupilumab 600 mg, followed by 300 mg maintenance dose with varying administration frequency tailored to individual patient response. All patients experienced at least some improvement in blister formation and pruritus, with 23 (76.7%) of patients demonstrating either complete clearance of blistering or marked response. Complete clearance of pruritus or marked response was noted in 25 (83.3%) of patients. Eight patients were effectively maintained solely on dupilumab. One (3.3%) patient reported an injection site reaction. Thirty patients represent a small sample, however, to our knowledge, this is the second largest group of BP treated with dupilumab. Furthermore, we provide an understandable framework for clinicians outside of academics to follow and assess treatment responses in their BP patients treated with dupilumab. Dupilumab should be considered as a therapeutic option in patients with bullous pemphigoid given its ability to induce sustained blistering and pruritus response in both typical and refractory cases while maintaining a favorable safety profile.
An Up-to-Date Approach to the Management of Dissecting Cellulitis
Dissecting cellulitis of the scalp (DCS) also known as perifolliculitis capitis abscedens et suffodiens (PCAS) is a chronic, relapsing, inflammatory dermatosis consisting of edematous sterile pustules and nodules resulting in sinus tracts and scarring alopecia. Although first described as infectious in 1903, DCS is primarily an inflammatory process that can precede a secondary infection; this is similarly true of the other conditions within the follicular occlusion tetrad: hidradenitis suppurativa (HS), acne conglobata, and pilonidal sinus.
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