Successful Oral Corticosteroid with Doxycycline as Adjuvant Therapy in a Case of Refractory Bullous Pemphigoid

Abstract

Bullous pemphigoid (PB) is a bullous autoimmune disease that often occurs in elderly people. It can be triggered by age, drug use, trauma, ultraviolet exposure, radiation, genetic roles and stress. Treatment of PB with topical and oral corticosteroid drugs remains the main option.1 However, recent control trial studies have shown the efficacy and safety of using doxycycline to reduce accumulated treatment dose and mortality. A 68-year-old male presented with widespread, itchy bullae that ruptured, releasing clear fluid and forming dark crusts. Physical examination revealed multiple tense bullae and erosions on the neck, trunk, and upper extremities. He was treated with oral and topical corticosteroids, wound care, topical moisturizers, and anti-inflammatory antibiotics. Clinical improvement was noted within 7 days, with continued follow-up over 2–3 months. Combined with oral and topical corticosteroids, doxycycline offers potential as a steroid-sparing agent to attenuate inflammation and prevent recurrence of PB.