Chapter 55 - Mucous Membrane Pemphigoid

Question 1

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Mild Involvement
Mouth
(4)

Answer 1

Topical corticosteroid (gels or ointments) twice daily/4 times daily

Topical corticosteroids under occlusion (eg, dental trays)

Topical calcineurin inhibitors

Intralesional corticosteroids

Question 2

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Mild Involvement
Nose
(3)

Answer 2

Irrigation with isotonic saline twice daily/thrice daily

Nasal lubricants

Topical corticosteroids (eg, via sprays, inhalers)

Question 3

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Mild Involvement
Anogenital region
(2)

Answer 3

Topical corticosteroids

Topical calcineurin inhibitors

Question 4

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Mild Involvement
Skin
(2)

Answer 4

Topical corticosteroids

Topical calcineurin inhibitors

Question 5

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Moderate Involvement

Answer 5

Local care measures
+
Dapsone 50-200 mg daily,
Prednisone 20-60 mg each morning, OR Both of these agents simultaneously

Question 6

TABLE 55-4
Treatments for Mucous Membrane Pemphigoid

Severe Involvement

Answer 6

Local care measures
+
- Prednisone (1 mg/kg each morning)
- Intravenous immunoglobulin (2 g/kg body weight over 2-3 days every 2-6 weeks for 4-6 months)
- Both of these agents simultaneously

+
- Azathioprine (2-2.5 mg/kg/day)
- Mycophenolate mofetil (1-2.5 g/day)
- Cyclophosphamide (1-2 mg/kg/day)
- Rituximab (375 mg/m2 weekly × 4 then every 4-6 months as needed, or 1000 mg on days 1 and 15 and then 500 mg at month 6)