Authors: Jerome H Check, Brooke Neumann, Diane L Check.
The case presented here describes a novel treatment for bullous pemphigoid that was extremely effective in a 68-year- old woman with a history of multiple sclerosis who developed a severe case of histopathologically confirmed diagnosis of bullous pemphigoid involving her trunk, back, and upper thighs. The lesions developed despite her 1 1⁄2 years of treatment with the immunosuppressive agent ocrelizumab prescribed to treat multiple sclerosis (MS). A well-known physician at a university medical center who diagnosed the BP prescribed tetracycline, but this showed no clinical benefit. She was treated with dextroamphetamine for the purpose of releasing more dopamine from sympathetic nerve endings. Dopamine is known to decrease cellular permeability, thus inhibiting hypothetical irritants from infusing into the skin causing this type of inflammatory response. She had been previously treated for over 30 years with dextroamphetamine, which completely stopped rapid progression of MS. She moved 1000 miles, and her neurologist switched her to ocrelizumab because of unfamiliarity with treating MS with dopaminergic drugs and prescribed her ocrelizumab. She had a total remission of her BP in one week. She has not had any more skin lesions now for over a year while on therapy. Since current medical treatments for BP are not very affective and with the knowledge that dextroamphetamine has previously demonstrated efficacy in ameliorating other severe treatment resistant skin disorders e.g., urticaria, eczema, and psoriasis, and mucous membrane disorders e.g., recurrent aphthous stomatitis, this off-label safe treatment should be considered for BP in treatment resistant cases.
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