How would you approach treating patients with biopsy-proven Hailey- Hailey disease refractory to multiple oral therapies (i.e tetracyclines, naltrexone, apremilast, glycopyrrolate, Cellcept), and requiring monthly steroid tapers for disease flares?   

I find Hailey-Hailey so challenging and so I often do throw the kitchen sink. Additional options behind what you mentioned include low-dose superficial XRT (recently reviewed in JAMA Dermatology), botulinum toxin, dupilumab, and oral jak inhibitors. My personal approach to those who respond to predn...

I personally have used botulinum toxin with excellent results.