Bullous Pemphigoid: The Evolving Treatment Landscape

Bullous pemphigoid (BP) management has changed dramatically over the past several decades. What was once a treatment landscape dominated by systemic corticosteroids has steadily evolved as clinicians have gained a deeper understanding of the disease itself.

In this conversation, Prince Adotama, MD, Assistant Professor at NYU Grossman School of Medicine, sits down with Naveed Sami, MD, Professor of Dermatology and Medicine at the University of Central Florida, to discuss how the science behind BP is reshaping clinical care. The two walk through how advances in immunology—particularly the recognition of IL-4 and IL-13 signaling in BP—have opened the door to more targeted therapies designed to control disease without broadly suppressing the immune system.

The discussion also highlights why treatment decisions in BP are rarely straightforward. Many patients are older and medically complex, often managing multiple comorbidities and medications. In this setting, clinicians must weigh disease control against safety, considering not only efficacy but also the risks associated with steroids, immunosuppressive therapies, and polypharmacy.

Drs Adotama and Sami also explore where newer biologic therapies are beginning to fit into the treatment landscape, including the recent FDA approval of dupilumab for bullous pemphigoid. Along the way, they discuss practical clinical considerations, from treatment response and remission goals to the role of combination therapy and emerging therapies on the horizon.

Together, their conversation reflects a broader shift in dermatology. As our understanding of disease biology improves, treatment strategies are becoming more precise, more individualized, and increasingly focused on improving both disease control and quality of life for patients living with BP.