{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:32Z","timestamp":1787552372534,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Bullous pemphigoid (BP) is a chronic autoimmune blistering disease predominantly affecting the elderly, with conventional immunosuppressive treatments often limited by insufficient efficacy and severe adverse effects. Emerging targeted therapies offer new opportunities, yet optimal treatment strategies remain to be defined. Herein, we report a case of BP in a 69-year-old woman with insufficient response to initial systemic corticosteroid therapy, successfully managed with a bridging targeted approach using abrocitinib and dupilumab. Initiation of abrocitinib (200 mg daily) resulted in rapid pruritus relief within 24 hours and cessation of new blister formation within 6 days. Symptom relapse and reinduction upon dose reduction and restoration suggested a dose-dependent therapeutic effect of abrocitinib. Dupilumab was subsequently introduced for long-term disease control, while abrocitinib was gradually tapered off. After more than six months of targeted therapy, sustained complete remission was achieved, with a favorable safety profile. Objective disease activity improved in parallel with clinical remission, with BPDAI decreasing from 120 at baseline to 0, pruritus NRS from 9 to 0, and peripheral eosinophil counts returning to the normal range during follow-up. Mechanistically, abrocitinib may rapidly suppress pruritus and inflammation through JAK1-dependent blockade of IL-4, IL-13, and IL-31 signaling. In contrast, dupilumab provides sustained disease control by inhibiting IL-4\/IL-13-mediated Th2 responses, reducing eosinophilic inflammation and autoantibody production. This case highlights a complementary therapeutic strategy integrating rapid disease control with long-term immune modulation, suggesting that our bridging therapy may represent a rational and effective approach for patients with bullous pemphigoid with insufficient response to initial corticosteroid therapy, warranting further investigation in controlled studies.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1906365","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:31:06Z","timestamp":1787549466000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Abrocitinib and dupilumab bridging therapy for bullous pemphigoid with insufficient response to initial corticosteroid therapy: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Hongchan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Longyou County Traditional Chinese Medicine Hospital","place":["Longyou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linqi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University","place":["Quzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University","place":["Quzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University","place":["Quzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University","place":["Quzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(12)61140-4","article-title":"Pemphigoid diseases","volume":"381","author":"Schmidt","year":"2013","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20743","article-title":"The global incidence of bullous pemphigoid: a systematic review and meta-analysis","volume":"186","author":"Persson","year":"2022","journal-title":"Br J 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