Research Progress on Targeted Therapies for Pemphigus Vulgaris and Bullous Pemphigoid: Mechanisms, Opportunities and Challenges

Autoimmune bullous diseases (AIBDs) are a group of severe disorders characterized by autoantibodies that attack structural proteins within the skin/mucosa, leading to blister and bullae formation. Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are among the most prevalent representative AIBDs. Traditional treatments involving corticosteroids and immunosuppressive agents are often associated with substantial adverse effects and a high rate of relapse. In recent years, the therapeutic landscape has evolved toward precision targeted therapies, encompassing biological agents, small-molecule drugs, and chimeric autoantibody receptor T cells. These novel interventions act on specific pathogenic targets, offering the potential to improve both efficacy and safety. This narrative review aims to summarize the latest progress in targeted therapies for PV and BP, compare the mechanisms of action, efficacy, and safety profiles of various treatments, and highlight current challenges and future research directions. In addition, therapeutic considerations for patients with concomitant psoriasis are discussed, given the increasing recognition of this comorbidity in clinical practice and the growing number of case reports describing the use of targeted agents in this specific population. Ultimately, the insights presented herein are intended to optimize clinical management strategies and guide future drug development.