Management of Bullous Pemphigoid in Special Populations: A Narrative Review of the Literature

Bullous pemphigoid (BP) mostly affects elderly patients who have age-related comorbidities, and BP itself is associated with neurologic comorbidities independently of the patients’ age. Identifying comorbidities in patients with newly diagnosed BP is important to define the prognosis, to choose the best therapeutic strategy, and to plan follow-ups. Comorbidities are associated with polypharmacy, and drug-induced BP should be always ruled out. Topical or systemic corticosteroids (CSs) represent the mainstay of treatment for BP. CS-sparing agents might be useful in frail patients and include dapsone, tetracyclines, methotrexate (MTX), mycophenolate mofetil (MMF), azathioprine (AZA), rituximab, omalizumab, dupilumab, intravenous immunoglobulins (IVIGs), and immunoadsorption. In this complex therapeutic scenario, clinicians should tailor the therapeutic approach accordingly to the patient’s characteristics. Preexisting and newly arising therapy-related comorbidities should be monitored during the patient’s follow-up.