[Use of very low doses of intravenous immunoglobulins for the treatment of bullous pemphigoid].

High dose intravenous immunoglobulins have proved effective immunosuppressants in various autoimmune diseases, including bullous pemphigoid. However, their specific point of impact remains undetermined and no study supports the need for high doses. We treated elderly patients with proven and corticosteroid-resistant bullous pemphigoid, using a therapeutic regimen consisting of continuous oral corticosteroid therapy and continuous infusion of immunoglobulins in very low doses by means of an electric syringe. Clinical improvement was observed in every case without any characteristic change in immunological parameters (anti-basal membrane antibody, cutaneous immune deposits), which suggests that immunoglobulins administered in that way act on immune response regulatory mechanisms. The therapeutic effect observed potentiates that of corticosteroids which can thus be given in lower doses in bullous pemphigoid.