# National clinical reaudit on managing adults with bullous pemphigoid 2024 highlighting shifting clinical practices

## TL;DR

This 2024 reaudit of bullous pemphigoid management in the UK shows changes in diagnosis and treatment, but ongoing issues with osteoporosis risk documentation remain.

## Contribution

The study reveals updated clinical practices in bullous pemphigoid management and highlights persistent gaps in guideline adherence.

## Key findings

- There is a shift toward indirect immunofluorescence for diagnosis.
- Doxycycline is increasingly used as first-line therapy.
- Osteoporosis risk documentation remains inadequate.

## Abstract

Bullous pemphigoid (BP) is a chronic, autoimmune, blistering disorder that predominantly affects older adults and is associated with significant morbidity and treatment challenges. The British Association of Dermatologists (BAD) clinical guideline for managing people with BP was published in 2012; a national clinical audit was undertaken in 2018. This 2024 reaudit evaluates changes in clinical practice, including diagnostic methods, treatment strategies and documentation standards.

To reassess compliance with BAD audit standards, compare findings with the 2018 audit and identify trends in BP management.

Over 9 weeks in 2024, BAD members submitted data for 450 cases of BP from 77 centres across the UK. Audit standards included documentation of comorbidities, osteoporosis risk management, patient satisfaction and systemic treatment monitoring.

The reaudit identified a shift in diagnostic practices, an increased proportion of severe baseline disease and continued gaps in ­osteoporosis risk documentation. The use of doxycycline as a primary treatment has increased significantly since 2018.

The findings highlight both progress and persistent challenges in BP management. Improved documentation and greater adherence to osteoporosis management guidelines remain priorities for future practice.

Bullous pemphigoid (BP) is the most common autoimmune blistering disorder affecting older adults, and this 2024 re-audit aimed to evaluate changes in diagnostic methods, treatment strategies and guideline adherence compared with the 2018 audit. Data from 450 BP cases across 77 UK centres revealed a shift towards indirect immunofluorescence for diagnosis, an increased use of doxycycline as first-line therapy, and a higher proportion of severe disease at presentation. The findings highlight ongoing challenges in osteoporosis risk management, variability in practice and a need for updated guidelines to better reflect evolving clinical practice and the growing role of teledermatology.