Use of dupilumab for localized bullous pemphigoid in an elderly indigenous woman residing in a Nunavik elders’ home: A case report

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, primarily affecting older adults. Standard treatment includes high-potency topical or systemic corticosteroids, often with immunosuppressive steroid-sparing agents; however, these therapies can be difficult to administer and monitor in remote settings. We report a 70-year-old Indigenous woman from a remote northern community who presented with localized BP of the right thigh. Initial treatment with topical clobetasol and mupirocin resulted in partial improvement, but ongoing management was complicated by limited access to specialist care, residence in an assisted living facility, challenges with prolonged topical therapy, and the need for routine laboratory monitoring for many systemic agents. Dupilumab was initiated with a 600 mg loading dose followed by 300 mg every two weeks. After 3 months, the patient achieved complete clinical resolution without adverse events. This case highlights dupilumab as a practical, effective, non-immunosuppressive treatment option for BP in resource-limited settings.