Effective response to high-frequency and prolonged dupilumab therapy in severe refractory bullous pemphigoid: A case study

Bullous pemphigoid (BP) is an autoimmune blistering disorder primarily affecting elderly individuals, with its incidence increasing with age. Standard treatments, such as glucocorticoids and immunosuppressive agents, are generally effective but often associated with notable side effects. More importantly, during the tapering phase of corticosteroid treatment, recurrence of erythema and blisters is common. There is growing demand for alternative or adjunctive therapies with fewer adverse effects and a low recurrence rate. Dupilumab, a humanized monoclonal IgG4 antibody targeting interleukin-4 (IL)-4 and IL-13 signaling, has shown efficacy in atopic dermatitis and asthma and has more recently been explored for its potential in bullous diseases. We present a case of a 65-year-old woman with BP who had an inadequate response to the conventional therapies. After the initiation of dupilumab, her skin lesions significantly improved, allowing corticosteroid use to be reduced. This case highlights both the short-term efficacy and long-term stability of dupilumab in managing severe refractory BP. As an adjunctive therapy, dupilumab may offer promising benefits in the treatment of refractory BP cases.