National clinical re-audit on managing adults with bullous pemphigoid 2024 highlighting shifting clinical practices

Background: Bullous pemphigoid (BP) is a chronic, autoimmune, blistering disorder that predominantly affects older adults and is associated with significant morbidity and treatment challenges. The British Association of Dermatologists (BAD) clinical guideline for managing people with BP were published in 2012; a national clinical audit was undertaken in 2018. This 2024 re-audit evaluates changes in clinical practice, including diagnostic methods, treatment strategies, and documentation standards.

Objective: To reassess compliance with BAD audit standards, compare findings with the 2018 audit, and identify trends in BP management.

Methods: Over nine weeks in 2024, BAD members submitted data for 450 BP cases from 77 centres across the UK. Audit standards included documentation of co-morbidities, osteoporosis risk management, patient satisfaction, and systemic treatment monitoring.

Results: The re-audit identified a shift in diagnostic practices, an increased proportion of severe baseline disease, and continued gaps in osteoporosis risk documentation. The use of doxycycline as a primary treatment has increased significantly since 2018.

Conclusions: The findings highlight both progress and persistent challenges in BP management. Improved documentation and greater adherence to osteoporosis management guidelines remain priorities for future practice.