Dupilumab for the Treatment of Recalcitrant Bullous Pemphigoid

Bullous pemphigoid (BP) is a pruritic autoimmune blistering disorder that most commonly affects elderly patients. Therapeutic options have limitations based on effectiveness, adverse effects, and patient comorbidities. They present a case of an elderly man with bullous pemphigoid successfully treated with dupilumab, an interleukin (IL)-4 alpha antagonist. A man in his 80s presented with a 6-week history of progressive pruritic tense bullae distributed over the trunk and extremities, with sparing of mucosal surfaces. The patient denied taking any new medications. Lesional and perilesional biopsies were performed, which revealed eosinophil- and neutrophil-rich subepidermal bullae with 3+ linear IgG immunoreactivity along the dermal-epidermal junction. A diagnosis of BP was made, and the patient started treatment with a prednisone taper.