The Role of Topical Corticosteroids in Bullous Pemphigoid in the Elderly
Tóm tắt
Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease. Until recently the condition was treated with oral corticosteroids. However, high-dose corticosteroids are poorly tolerated in the elderly and their use has probably contributed to the high mortality rates observed in several cohorts. Accordingly, considerable effort has been directed at identifying corticosteroid-sparing agents, such as immunosuppressant drugs, plasma exchange techniques, intravenous immunoglobulins and tetracycline, that can be used in this clinical setting. Many of these options have appeared to be useful in open series, but they have been found to be ineffective or only marginally effective when tested in randomised, controlled trials. An important breakthrough occurred with the demonstration in a large, randomised trial that a ‘super-potent’ topical corticosteroid (clobetasol propionate) was not only associated with a significant decrease in severe complications and mortality of BP patients, but was also more effective than oral prednisone. New strategies for BP should include topical clobetasol propionate as first-line therapy in the elderly and consider adjuvant therapy only in the very rare cases that are either resistant or intolerant to this treatment.
Tài liệu tham khảo
Korman NJ. Bullous pemphigoid: the latest in diagnosis, prognosis and therapy. Arch Dermatol 1998; 134: 1137–41
Nousari HC, Anhalt GJ. Pemphigus and bullous pemphigoid. Lancet 1999; 354: 667–72
Yancey KB, Egan CA. Pemphigoid: clinical, histologie, immu-nopathologic, and therapeutic considerations. JAMA 2000; 284: 350–6
Bernard P, Vaillant L, Labeille B, et al. Incidence and distribution of subepidermal autoimmune bullous skin diseases in three French regions. Arch Dermatol 1995; 131: 48–52
Zillikens D, Wever S, Roth A, et al. Incidence of autoimmune subepidermal blistering dermatoses in a region of central Germany. Arch Dermatol 1995; 131: 957–8
Courville P, Kupfer I, Gilbert D, et al. Evaluation of histological criteria for bullous pemphigoid: correlation with antigens recognized by immunoblotting of anti-epidermal autoantibodies. Ann Pathol 2000; 20: 564–9
Gammon WR, Kowalewski C, Chorzelski TP, et al. Direct immunofluorescence studies of sodium chloride-separated skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita. J Am Acad Dermatol 1990; 22: 664–70
Joly P, Gilbert D, Thomine E, et al. Relationship between the in vivo localization and the immunoblotting pattern of anti-basement membrane zone antibodies in patients with bullous pemphigoid. Arch Dermatol 1997; 133: 719–24
Stanley JR, Tanaka T, Mueller S, et al. Isolation of complementary DNA for bullous pemphigoid antigen by use of patients’ autoantibodies. J Clin Invest 1988; 82: 1864–70
Diaz LA, Ratrie H, Saunders WS, et al. Isolation of a human cDNA corresponding to the 180 kD autoantigen recognized by bullous pemphigoid and herpes gestationis sera: immunolocal-ization of this protein to the hemidesmosome. J Clin Invest 1990; 86: 1088–94
Tanaka T, Parry DA, Klaus-Kovtun V, et al. Comparison of molecularly cloned bullous pemphigoid antigen to desmoplakin I confirms that they define a new family of cell adhesion junction plaque proteins. J Biol Chem 1991; 266: 1255–9
Giudice GJ, Emery DJ, Diaz LA. Cloning and primary structural analysis of the bullous pemphigoid autoantigen BP180. J Invest Dermatol 1992; 99: 243–50
Liu Z, Diaz LA, Troy JL, et al. A passive transfer model of the organ-specific auto-immune disease, bullous pemphigoid, using antibodies generated against the hemidesmosomal antigen BP180. J Clin Invest 1993; 92: 2480–8
Bernard P, Bedane C, Bonnetblanc JM. Anti-BP180 autoantibodies as a marker of poor prognosis in bullous pemphigoid: a cohort analysis of 94 elderly patients. Br J Dermatol 1997; 136: 694–8
Schmidt E, Obe K, Brocker EB, et al. Serum levels of autoantibodies to BP180 correlate with disease activity in patients with bullous pemphigoid. Arch Dermatol 2000; 136: 174–8
Zillikens D. BP180 as the common autoantigen in blistering diseases with different clinical phenotypes. Keio J Med 2002; 51: 21–8
Vaillant L, Bernard P, Joly P, et al. Evaluation of clinical criteria for diagnosis of bullous pemphigoid. Arch Dermatol 1998; 134: 1075–80
Joly P, Courville P, Lok C, et al. Clinical criteria for the diagnosis of bullous pemphigoid: a reevaluation according to immunoblot analysis of patient sera. Dermatology 2004; 208: 16–20
Roujeau JC, Guillaume JC, Morel P, et al. Plasma exchange in bullous pemphigoid. Lancet 1984; II: 486–8
Dreno B, Sassolas B, Lacour P, et al. Methylprednisolone versus prednisolone methylsulfobenzoate in pemphigoid: a comparative multicenter study. Ann Dermatol Venereol 1993; 120: 518–21
Morel P, Guillaume JC. Treatment of bullous pemphigoid with prednisolone only: 0.75 mg/kg/day versus 1.25 mg/kg/day, a multicenter randomized study. Ann Dermatol Venereol 1984; 111: 925–8
Guillaume JC, Vaillant L, Bernard P, et al. Controlled trial of azathioprine and plasma exchange in addition to prednisolone in the treatment of bullous pemphigoid. Arch Dermatol 1993; 129: 49–53
Lebrun-Vignes B, Roujeau JC, Bernard P, et al. Prednisone is more effective than prednisolone metasulfobenzoate in the treatment of bullous pemphigoid. Arch Dermatol 1999; 135: 89–90
Savin JA. The events leading to the death of patients with pemphigus and pemphigoid. Br J Dermatol 1979; 101: 521–34
Venning VA, Wojnarowska F. Lack of predictive factors for the clinical course of bullous pemphigoid. J Am Acad Dermatol 1992; 26: 585–9
Roujeau JC, Lok C, Bastuji-Garin S, et al. High risk of death in elderly patients with extensive bullous pemphigoid. Arch Dermatol 1998; 134: 465–9
Joly P, Roujeau JC, Lok C, et al. Survival of patients with bullous pemphigoid: a prospective study. Arch Dermatol 2005; 141: 1–8
Joly P, Roujeau JC, Benichou J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 2002; 346: 321–7
Rzany B, Partscht K, Jung M, et al. Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticoids, and old age. Arch Dermatol 2002; 138: 903–8
Westerhof W. Treatment of bullous pemphigoid with topical clobetasol propionate. J Am Acad Dermatol 1989; 20: 458–61
Paquet P, Richelle M, Lapiere CM. Bullous pemphigoid treated by topical corticosteroids. Acta Derm Venereol 1991; 71: 534–5
Muramatsu T, Iida T, Shirai T. Pemphigoid and pemphigus foliaceus successfully treated with topical corticosteroids. J Dermatol 1996; 23: 683–8
Spuls PI, Brakman M, Westerhof W, et al. Treatment of generalized bullous pemphigoid with topical corticosteroids [letter]. Acta Derm Venereol 1995; 75: 89
Zimmermann R, Faure M, Claudy A. Prospective study of treatment of bullous pemphigoid by a class I topical corticoste-roid. Ann Dermatol Venereol 1999; 126: 13–6
Liu Z, Shipley JM, Vu TH, et al. Gelatinase B-deficient mice are resistant to experimental bullous pemphigoid. J Exp Med 1998; 188: 475–82
Staughton RC, August PJ. Cushing’s syndrome and pituitary-adrenal suppression due to clobetasol propionate. BMJ 1975; 2: 419–21
Walsh P, Aeling JL, Huff L, et al. Hypothalamus-pituitary-adrenal axis suppression by superpotent topical steroids. J Am Acad Dermatol 1993; 29: 501–3
Gilbertson EO, Spellman MC, Piacquadio DJ, et al. Super potent topical corticosteroid use associated with adrenal suppression: clinical considerations. J Am Acad Dermatol 1998; 38: 318–21
Dereure O, Bessis D, Guillot B, et al. Treatment of bullous pemphigoid by low-dose methotrexate associated with short-term potent topical steroids: an open prospective study of 18 cases. Arch Dermatol 2002; 138: 1255–6