BG02 (P062) National clinical reaudit on managing adults with bullous pemphigoid 2024: shifting clinical practices

Abstract Bullous pemphigoid (BP) is the most prevalent auto­immune blistering disorder in Western populations. It disproportionately affects older adults and is associated with significant morbidity. Following the British Association of Dermatologists (BAD) 2012 clinical guideline for BP management (Venning VA, Taghipour K, Mohd Mustapa MF et al. British Association of Dermatologists’ guidelines for the management of bullous pemphigoid 2012. Br J Dermatol 2012; 167: 1200–14), a national audit was conducted in 2018 (Smith H, Mohd Mustapa MF, Cheung ST, de Berker DAR. National audit on the management of bullous pemphigoid. Clin Exp Dermatol 2020; 45: 289–94). This 2024 reaudit aims to evaluate changes in diagnostic and treatment practices, identify persistent gaps in care, and assess compliance with audit standards. Further goals were to reassess adherence to BAD audit standards, compare clinical practices with the 2018 audit, and identify trends in BP management, particularly in the context of the COVID-19 pandemic. Over a 9-week period (February to April 2024), data from 450 cases of BP across 77 UK centres were collected via a standardized pro forma. The audit assessed diagnostic methods, comorbidity documentation, osteoporosis risk management, patient satisfaction and systemic treatment monitoring. Statistical comparisons with the 2018 audit were performed using χ2-tests, with P < 0.05 considered significant. Participation rates increased from 24.7% (2018) to 32.2% (2024). Diagnostic practices shifted towards greater use of indirect immunofluorescence (18.9% in 2024 vs. 10.3% in 2018, P = 0.03), while reliance on direct immunofluorescence decreased (35.3% in 2024 vs. 41.6% in 2018, P = 0.04). Disease severity at presentation increased, with severe cases (> 30 blisters) rising from 5.4% in 2018 to 23.1% in 2024 (P < 0.001). The use of doxy­cycline as first-line treatment rose significantly (83.8% in 2024 vs. 50.7% in 2018, P < 0.001), while azathioprine was less frequently prescribed, reflecting a shift towards mycophenolate mofetil. Documentation of osteoporosis risk and bone protection therapy declined (36.7% in 2024 vs. 38.4% in 2018, and 64.6% in 2024 vs. 75.6% in 2018, P = 0.004). Documentation of patient satisfaction improved from 59.3% in 2018 to 65.1% in 2024. The 2024 reaudit highlights a shift in diagnostic practices and treatment preferences, and an increase in disease severity at presentation. Improved documentation and adherence to osteoporosis management guidelines remain priorities. The continued reliance on oral corticosteroids despite increased doxycycline use suggests caution in transitioning to safer options. These findings emphasize the need for updated BP management guidelines and targeted educational initiatives to support best practice.