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Previous Volume 346:321-327 January 31, 2002 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Stern, R. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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.

Source Information

From the Departments of Dermatology and Biostatistics, INSERM Unite 519, University of Rouen, Rouen (P.J., J.B., P.Y.); and the Departments of Dermatology at the University of Paris XII, Creteil (J.-C.R.); Bichat University, Paris (C.P.); the University of Nantes, Nantes (B.D.); the University of Lille, Lille (E.D.); the University of Tours, Tours (L.V.); the University of Clermont-Ferrand, Clermont-Ferrand (M.D.); the General Hospital of Quimper, Quimper (P.P.); the University of Limoges, Limoges (C.B.); and the University of Reims, Reims (P.B.) — all in France.

Address reprint requests to Dr. Joly at the Clinique Dermatologique, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen CEDEX, France, or at pascal.joly{at}chu-rouen.fr.

Full Text of this Article

Related Letters:

Oral and Topical Corticosteroids in Bullous Pemphigoid
Korman N. J., Ardern-Jones M. R., Venning V. A., Wojnarowska F., Bystryn J.-C., Wainwright B. D., Shupack J. L., Spigel G. T., Joly P., Roujeau J.-C., Benichou J., Stern R. S.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:143-145, Jul 11, 2002. Correspondence

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