Use of Tralokinumab in the Management of Bullous Pemphigoid

Abstract

A 78-year-old female with a history of asthma and depression presented with several months of generalized pruritus and tense blisters involving the trunk and extremities. She was previously diagnosed with bullous pemphigoid by an allergist based on clinical findings and positive indirect immunofluorescence and had been treated with prednisone and doxycycline for nearly a year. She experienced intermittent symptom improvement and developed steroid-related side effects including hypertension, prediabetes, and weight gain. At her initial visit with dermatology, she had discontinued prednisone and reported a peak pruritic numerical rating scale (PP-NRS) of 10/10 with numerous bullae on examination.  Dupilumab was initiated with rapid improvement in pruritic and skin lesions, with clear skin by six months. However, at 12 months, she developed progressive arthralgia affecting large and small joints without any identifiable cause. Due to emerging reports of dupilumab-associated inflammatory arthritis, the medication was discontinued and replaced with tralokinumab. At the 4-month follow-up, the patient remained clear and itch-free, and her arthralgia had fully resolved. She did report a mild flare during the first month of treatment, which resolved quickly with continued therapy.