Patience and expertise are required for bullous pemphigoid

Direct and indirect immunofluorescence are still the gold standard for the detection of specific antibodies and autoantibodies in bullous pemphigoid. Highly effective topical steroids or systemic corticosteroids are recommended as first-line therapy. In the event of a lack of response or contraindications, immunomodulatory and immunosuppressive drugs can be used. According to several case reports, omalizumab and dupilumab have proven to be effective treatment options and further biologics are currently being researched.