LOW-DOSE METHOTREXATE TREATMENT IN ELDERLY PATIENTS WITH BULLOUS PEMPHIGOID

Background: Various treatments have been used for elderly patients wit h bullous pemphigoid. The most common is moderate-dose to high-dose pr ednisone, either alone or in combination with other oral or topical ag ents. Objective: The aim of this study was to evaluate the efficacy of low-dose methotrexate as a steroid-sparing agent in patients with bul lous pemphigoid. Methods. A retrospective chart review of 34 patients with bullous pemphigoid seen from 1989 through the first half of 1993 was conducted. The diagnosis of bullous pemphigoid was confirmed by di rect or indirect immunofluorescence microscopy, or salt-split skin sec tions. Eight of 34 elderly (> 60 years old) patients with therapy-resi stant bullous pemphigoid received low-dose weekly methotrexate (averag e, 5 to 10 mg) in combination with oral prednisone. Results: Patients who received combination therapy required significantly lower (p less than or equal to 0.02) doses of prednisone to control their disease at 1 month compared with baseline doses. Conclusion: In this elderly pat ient population the side effect profile of the methotrexate was accept able and well tolerated. We therefore recommend methotrexate and low-d ose corticosteroid as first-line combination therapy for selected elde rly patients with bullous pemphigoid.