Discussion Treatment of BP can be challenging, especially in refractory cases. Oral
corticosteroids are the most common initial therapy for BP, but they are not ideal for long-
term treatment owing to their adverse effect profile. 1 Alternative agents with reported
efficacy include azathioprine, mycophenolate mofetil, methotrexate, cyclosporine,
cyclophosphamide, rituximab, dapsone, plasma exchange, and antibiotics. 1