Omalizumab Therapy for Bullous Pemphigoid: A Case Report

TL;DR

This case report describes a patient with bullous pemphigoid successfully treated with omalizumab after failing traditional therapies.

Contribution

The report highlights omalizumab as a promising treatment for refractory bullous pemphigoid.

Findings

Omalizumab, combined with IVIG and antibiotics, led to clinical improvement in a patient with resistant bullous pemphigoid.

The treatment allowed successful tapering of corticosteroids and prevented new blister formation.

Omalizumab shows potential as a therapeutic option for difficult-to-treat bullous pemphigoid cases.

Abstract

Bullous pemphigoid (BP) is a chronic autoimmune blistering disease characterized by the presence of autoantibodies that target hemidesmosomal proteins, specifically BP180 and BP230. This immune response leads to the formation of subepidermal blisters and inflammation. The primary treatment for BP involves systemic corticosteroids; however, long-term use can result in significant adverse effects, and some patients may experience resistance to steroid therapy. We report the case of a 62-year-old male with multiple comorbidities who developed progressive, itchy blisters and extensive skin erosions affecting more than 50% of his body surface. Although he initially showed improvement with intravenous corticosteroids, new blister formation continued, and Staphylococcus aureus bacteremia prevented further use of immunosuppressive therapy. The patient was managed with targeted antibiotics, intravenous immunoglobulin (IVIG), and omalizumab. This treatment resulted in significant clinical improvement, the resolution of new blister formation, and a successful tapering of corticosteroids. Omalizumab has demonstrated promising efficacy in treating BP, especially in refractory cases. Given its favorable safety profile, further clinical trials are needed to determine its long-term role in the management of BP.

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