Autoimmune bullous dermatoses

Prescribing Notes:

General notes

• The place in therapy is directed by a dermatology specialist prescriber experienced in the management of the condition, use is in line with relevant local or national guidance.
• Depending on the severity of the condition, topical treatments may be appropriate, for formulary recommendations see pathways for eczema, treatment with potent topical corticosteroids.
• Systemic treatments for autoimmune bullous dermatoses are initiated by specialists. 
• For treatments continuing in primary care responsibility for monitoring to be agreed, refer to individual board shared care policies for more information.
• For patients with swallowing difficulties prednisolone oral solution or soluble tablets may be considered. Prednisolone tablets may be dispersed in water as an alternative to soluble tablets or oral solution preparations. This is an off-label use but more cost-effective option. Refer to local board policies on the use of unlicensed (and off-label) medicines for further guidance.

Azathioprine

• Azathioprine can be prescribed, after specialist initiation, as a steroid sparing agent in severe autoimmune bullous dermatoses. The licence status depends on the condition being treated; azathioprine is licensed for use in pemphigous vulgaris. Azathioprine is contraindicated if there is absent or very low thiopurine methyltransferase (TPMT) activity.

Mycophenolate mofetil

• Mycophenolate mofetil (off-label) can be prescribed, after specialist initiation, for patients with moderate to severe immunobullous disorders requiring steroid sparing immunosuppression.