title: A comparison of oral and topical corticosteroids in patients with bullous pemphigoid.
abstract: BACKGROUND
  Bullous pemphigoid is the most common autoimmune blistering skin disease of the elderly. Because elderly people have low tolerance for standard regimens of oral corticosteroids, we studied whether highly potent topical corticosteroids could decrease mortality while controlling disease.
  
  
  METHODS
  A total of 341 patients with bullous pemphigoid were enrolled in a randomized, multicenter trial and stratified according to the severity of their disease (moderate or extensive). Patients were randomly assigned to receive either topical clobetasol propionate cream (40 g per day) or oral prednisone (0.5 mg per kilogram of body weight per day for those with moderate disease and 1 mg per kilogram per day for those with extensive disease). The primary end point was overall survival.
  
  
  RESULTS
  Among the 188 patients with extensive bullous pemphigoid, topical corticosteroids were superior to oral prednisone (P=0.02). The one-year survival rate was 76 percent in the topical-corticosteroid group and 58 percent in the oral-prednisone group. Disease was controlled at three weeks in 92 of the 93 patients in the topical-corticosteroid group (99 percent) and 86 of the 95 patients in the oral-prednisone group (91 percent, P=0.02). Severe complications occurred in 27 of the 93 patients in the topical-corticosteroid group (29 percent) and in 51 of the 95 patients in the oral-prednisone group (54 percent, P=0.006). Among the 153 patients with moderate bullous pemphigoid, there were no significant differences between the topical-corticosteroid group and the oral-prednisone group in terms of overall survival, the rate of control at three weeks, or the incidence of severe complications.
  
  
  CONCLUSIONS
  Topical corticosteroid therapy is effective for both moderate and severe bullous pemphigoid and is superior to oral corticosteroid therapy for extensive disease.
authors.affiliation: Department of Dermatology and Biostatistics, INSERM Unite 519, University of Rouen, Rouen, France. pascal.joly@chu-rouen.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Roujeau
authors.forename: Jacques
authors.initials: J
authors.lastname: Benichou
authors.forename: Catherine
authors.initials: C
authors.lastname: Picard
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Delaporte
authors.forename: Loic
authors.initials: L
authors.lastname: Vaillant
authors.forename: Michel
authors.initials: M
authors.lastname: D'Incan
authors.forename: Patrice
authors.initials: P
authors.lastname: Plantin
authors.forename: Christophe
authors.initials: C
authors.lastname: Bedane
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.forename: Philippe
authors.initials: P
authors.lastname: Bernard
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D002990:Clobetasol / Q000008:administration & dosage* / Q000009:adverse effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D009824:Ointments; D010391:Pemphigoid, Bullous / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D012008:Recurrence; D015996:Survival Rate
chemical_list: D005938:Glucocorticoids; D009824:Ointments; D002990:Clobetasol; D011241:Prednisone