Optimizing Local Treatment in Pemphigus and Pemphigoid: Current Evidence and Unmet Needs

Autoimmune blistering diseases (AIBDs), including pemphigus vulgaris (PV) and bullous pemphigoid (BP), are characterized by painful erosions and chronic wounds that significantly impair patient quality of life. While systemic therapies remain the cornerstone of treatment, optimal strategies for local management, including wound care and topical therapies, are not well defined. The aim of this study is to review and synthesize current evidence on topical treatments and wound care strategies in AIBDs, with a focus on their role in disease control, infection prevention, and enhancement of healing. A narrative review of the literature was conducted using PubMed-indexed articles and guidelines relevant to topical corticosteroids, calcineurin inhibitors, antiseptics, antibiotics, and wound dressings in the management of PV, BP, and related disorders. Topical corticosteroids, particularly clobetasol propionate, are the first-line treatment for BP and play an adjunctive role in PV. Topical calcineurin inhibitors have shown promise as steroid-sparing agents in localized disease, though evidence remains limited. Antiseptics such as chlorhexidine may aid in infection control, though clinical data are sparse. Topical antibiotics like mupirocin and fusidic acid might be used in case of secondary infection or critical colonization. Dressing selection-favoring non-adherent, antimicrobial, or moisture-retentive options-is crucial to minimize trauma, promote healing, and prevent complications, particularly in elderly or high-risk patients. Topical therapies and wound care are essential components in the management of AIBDs but remain understudied and poorly standardized. Evidence supports the use of high-potency corticosteroids in BP and adjunctive use in PV, while promising data on antiseptics and advanced dressings warrant further investigation. Well-designed clinical trials are needed to establish evidence-based guidelines in this setting.