Can we cure bullous skin diseases?

Abstract

Autoimmune bullous diseases (AIBDs), including pemphigus and pemphigoid, are featured as the presence of autoantibodies directed against structural proteins, resulting in severe blistering as well as considerable morbidity. Current treatments, including glucocorticoids, immunomodulators, and biologics, often fail to achieve sustained remission due to high relapse rates and significant adverse effects. This review explores the pathophysiology of AIBDs, focusing on autoreactive B and T cells, inflammatory mediators, and immune dysregulation. Existing therapeutic limitations are then analyzed, and emerging treatment options, such as chimeric antigen receptor-T therapy, regulatory T cell-based interventions, and tolerogenic vaccines, are discussed as potential curative approaches. Additionally, preventive measures, such as genetic screening and environmental risk management, are considered. By integrating novel immunotherapies and immune modulation techniques through a three-step approach - disease control, pathogenic cell elimination, and induction of immune tolerance - we may move closer toward achieving sustained remission and potentially curing of AIBDs.