Bullous pemphigoid: A practical approach to diagnosis and management in the modern era

Abstract

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, primarily presenting with tense bullae and severe pruritus. Diagnosing and treating BP can be challenging due to its variable clinical presentations. We will briefly discuss these phenotypes, highlight diagnostic basics, and briefly summarize recent laboratory advancements that have improved diagnostic sensitivity and accuracy. The treatment landscape for BP has evolved significantly. Newer therapies, including biologics such as rituximab, omalizumab, dupilumab, and Janus kinase inhibitors target the immunopathogenesis of BP and can reduce the adverse effects associated with cumulative corticosteroid exposure and conventional immunosuppressants. This article provides a comprehensive overview of BP's clinical features, diagnostic approaches, and emerging therapeutic options, emphasizing personalized medicine, and improved patient outcomes.

Keywords: Janus kinase inhibitor; bullous pemphigoid; dermatology; dipeptidyl peptidase-4 inhibitors; dupilumab; efgartigimod; immune checkpoint inhibitor; immunofluroescence; intravenous immunoglobulin; omalizumab; pemphigoid; rituximab; salt split skin.