Systemic corticosteroids have been used extensively for 50 years in the management of inflammatory skin disorders and have become the mainstay of treatment for immunobullous disorders.¹ Unfortunately, this treatment is associated with multiple potentially serious adverse effects. As a result, physicians have attempted to find efficacious corticosteroid-sparing agents to avoid the unwanted adverse effects of systemic corticosteroids. A recently published study² demonstrated that high-potency topical corticosteroids were safer and more effective than systemic therapy in patients with bullous pemphigoid.

We attempted to treat a patient with linear IgA bullous dermatosis, a variant of bullous pemphigoid, in a similar manner. A side-side comparison was initiated with 0.05% clobetasol ointment and 0.1% tacrolimus ointment applied to opposite sides of the body (entire body surface area, sparing face) 1 to 2 times each day. Control of disease activity was achieved by day 21 using clobetasol, but the patient continued to develop new bullae on the side treated with tacrolimus. However, she developed extensive striae (Figure 1) on areas treated with clobetasol, and this was apparent within 1 month of starting treatment. Joly et al² reported that their patients treated topically had shorter hospitalizations, more rapid control of disease activity, fewer severe complications, and lower mortality rates than patients treated with systemic corticosteroids. No mention was made to cutaneous side effects. Striae, purpura, telangiectasias, and atrophy are well known adverse effects of corticosteroid use.