Bullous pemphigoid. New directions of therapy, prospects for the future (literature review)

Abstract

Bullous pemphigoid (BP) is an autoimmune subepidermal bullous dermatosis that significantly affects the quality of life of patients due to pronounced subjective symptoms, affecting mainly the elderly. Autoantibodies against hemidesmosomal proteins BP180 and BP230 are involved in the pathogenesis of BP, which leads to detachment at the junction of the dermis and epidermis, as well as the formation of blisters. The severity, prevalence of the pathological process and painful itching require the appointment of high doses or constant use of systemic glucocorticoids, which is not always possible due to extensive concomitant pathology and a large list of side effects. The article presents modern methods of bullous pemphigoid therapy using monoclonal antibodies (rituximab, dupilumab, omalizumab). The mechanisms of therapeutic effect of the drugs described in the article are aimed at various pathways of immunopathogenesis of bullous pemphigoid. The new treatment methods described in the article offer alternative ways of helping patients who have contraindications to the appointment of systemic glucocorticosteroids, demonstrating the lack of effect from the use of basic therapy, with a recurrent process. New therapeutic techniques will improve results and reduce high cumulative doses of systemic corticosteroids and their associated toxic effects.