Vesiculobullous: topical therapy for bullous pemphigoid: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Vesiculobullous: topical therapy for bullous pemphigoid

Sample item

An 80-year-old man has localised tense bullae on the flexures and limbs with positive linear IgG and C3 at the basement membrane. Which first-line therapy is supported by evidence and reduces systemic risk?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Potent topical corticosteroid such as clobetasol propionate

In bullous pemphigoid, even extensive disease responds to superpotent topical steroid, which gives lower mortality and fewer adverse effects than high-dose oral prednisolone in the elderly. Systemic steroids or adjuvants are reserved for refractory disease. Retinoids and cyclophosphamide are not first line.

Option by option

  • A. Systemic isotretinoin

    Isotretinoin is not a treatment for pemphigoid.

  • B. Oral acitretin

    Acitretin is used in psoriasis and keratinisation disorders.

  • C. High-dose cyclophosphamide

    Cyclophosphamide is reserved for refractory disease and has serious toxicity.

  • D. Potent topical corticosteroid such as clobetasol propionate (correct)

    Correct. Clobetasol is a safe first-line option in frail elderly patients.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is D, Potent topical corticosteroid such as clobetasol propionate. In bullous pemphigoid, even extensive disease responds to superpotent topical steroid, which gives lower mortality and fewer adverse effects than high-dose oral prednisolone in the elderly.

Why is "Systemic isotretinoin" not the answer?

Isotretinoin is not a treatment for pemphigoid.

Why is "Oral acitretin" not the answer?

Acitretin is used in psoriasis and keratinisation disorders.

Why is "High-dose cyclophosphamide" not the answer?

Cyclophosphamide is reserved for refractory disease and has serious toxicity.

What concept does this question test?

It tests Vesiculobullous: topical therapy for bullous pemphigoid in Dermatology. Systemic steroids or adjuvants are reserved for refractory disease. Retinoids and cyclophosphamide are not first line.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vesiculobullous: topical therapy for bullous pemphigoid?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.