Tetracycline and nicotinamide for the treatment of bullous pemphigoid: our experience in Singapore.

Aim of study: To study the efficacy of tetracycline (or doxycycline) and nicotinamide in the treatment of less extensive bullous pemphigoid. Methods: An open trial of 11 patients with bullous pemphigoid. Treatment was initiated with tetracycline 1.5-2 g/day and nicotinamide 1.5-2 g/day and gradually tapered down. Doxycycline was substituted for tetracycline in patients who could not tolerate tetracycline due to gastrointestinal side effects or headache. Results: 6 out of 11 patients achieved complete response (>90% decrease in lesions) while another 2 had partial response (50-90% decrease in lesions). Conclusion: Tetracycline/doxycycline and nicotinamide is a useful alternative treatment for localized bullous pemphigoid, especially in those whose concurrent medical illnesses preclude the use of systemic corticosteroids.