Results of a survey of German dermatologists on the therapeutic approaches to pemphigus and bullous pemphigoid

Background: The lack of controlled trials on the treatment of pemphigus and pemphigoid diseases limits an evidence-based therapy of these disorders. The aim of this survey was to assess the current treatment standards at German dermatological hospitals and the need for future therapeutic trials. Methods: A two-page questionnaire was sent to 42 German academic and non-academic dermatological hospitals and evaluated at the Department of Dermatology, University Medical Center, Freiburg. Results: The response rate was 76 %. Topical clobetasol propionate treatment was regarded as first line therapy of bullous pemphigoid in 27% of the hospitals. More than 50% used systemic corticosteroids at an initial dose of <= 1 mg/kg prednisolone-equivalent in pemphigus and pemphigoid. Azathioprine is used as first line adjuvant in pemphigoid and pemphigus treatment in 69 % and 81 % of the hospitals, respectively. Dapsone and mycophenolate mofetil represent alternative options, as well as cyclophosphamide-dexamethasone-pulse therapy in pemphigus. Immunosuppressive treatment of pemphigoid and pemphigus is terminated by 58 % and 46 % of the hospitals 1-3 months after clinical remission, respectively, but the given time points appeared to be variable. Conclusions: The high response rate to this survey demonstrates the interest in this topic. The variability of the answers regarding initial doses of corticosteroids and time points for termination of therapy indicates the need for the establishment of guidelines and for controlled therapeutic trials.