What is your approach to tapering treatments for patients with bullous pemphigoid?

The tapering of medications in bullous pemphigoid (BP) primarily involves systemic corticosteroids, which are the mainstay of treatment. According to European guidelines, an initial dose of 0.5 mg/kg per day of oral prednisone is recommended for BP. Once disease control is achieved and the patient no longer has any skin lesions, the prednisone dose should be gradually tapered with the goal of discontinuing the medication or maintaining a minimal dose (0.1 mg/kg per day) within six months. You ca...

Oral steroids are generally for acute management and can be tapered as other drugs like doxycycline kick in...typically over a month. Doxy controls most patients pretty well and is safe for long-term Rx. I generally try to taper doxy after a few months without symptoms. Dupilumab is also useful when doxy fails to get patients off pred.

There are always exceptions, of course.

If the literature actually reflects practice, in Europe, they do it all with topicals... doubtful if their BP is like th...