In a related editorial, the authors discuss the finding of the study, including safety data, and conclude that “doxycycline is clearly safer than prednisolone for the treatment of bullous pemphigoid and demonstrates a reduced success rate, based on achieving three or fewer blisters, at 6 weeks. The evidence for non-inferiority is subjective, dependent on the definition of the clinically relevant non-inferiority boundary. However, given the natural history of bullous pemphigoid, and previous responses to topical treatment alone, it is rational to deduce that doxycycline is at least partly effective. Therefore it would seem reasonable to introduce doxycycline initially in combination with potent (or super-potent) topical steroids; if control is inadequate, treatment can then be escalated to systemic steroids (although this was not covered in the trial design). An alternative strategy, identified by the authors as a potential future trial, would be to start all patients on prednisolone to gain initial control, and then consider doxycycline as a potential maintenance treatment—with patients randomly assigned to continuation of oral corticosteroids or doxycycline”.