Bullous pemphigoid: Its incidence, mortality and clinical outcome in New Zealand

Clinical Outcomes and Prognostic Factors in Bullous Pemphigoid Patients: A 15-Year Review in China

BACKGROUND

There are limited data on clinical outcomes and prognosis factors for bullous pemphigoid (BP) at long-term follow-up.

OBJECTIVE

We aimed to investigate the clinical outcomes and prognostic factors in BP patients.

METHODS

This retrospective study was performed between January 1, 2009 and December 31, 2023 in Shandong Province, China. The primary outcomes were the rates and predictive factors of mortality, complete remission off-therapy (CROT), and relapse by Cox proportional hazards models or logistic regression analyses. Nomograms for BP mortality and CROT were also described.

RESULTS

Of the 1063 BP patients enrolled, 45 were excluded due to loss to follow-up. The cohort comprised 1018 BP patients to analyze. A total of 344 (33.8%) patients died, with cumulative 1-, 3-, and 5-year mortality rates of 22.8%, 31.2%, and 34.5%, respectively. Increased age at onset (HR = 1.08), body surface area (BSA) involvement 10-30%, BSA involvement > 30% (HR = 7.19; HR = 9.84, respectively), double-positive IgG and C3 on DIF (HR = 1.37), and systemic corticosteroid in combination  with immunosuppressants treatments (HR = 0.50) were associated with mortality. A total of 321 (31.5%) patients achieved CROT. Cumulative CROT rates at 1, 3, and 5 years were 10.9%, 32.9%, and 47.5%, respectively. Shorter diagnosis delay time (HR = 1.01), baseline anti-BP180 antibody < 50 IU/mL (HR = 1.48) and systemic drugs other than corticosteroid treatment (HR = 1.68) were associated with CROT. Predictive models demonstrated outstanding performance in classifying mortality at 1, 3, and 5 years (AUCs 0.83, 0.86, 0.88), but moderate classification for CROT (AUCs 0.67, 0.62, 0.63). A total of 749 (73.6%) patients experienced relapses.

CONCLUSIONS

This study, the first large cohort to examine long-term outcomes in BP patients, identifies risk factors for mortality and CROT, offering key insights for clinicians to improve prognosis and reduce relapse rates.

An integrative Chinese herbal medicine and ointment therapy for bullous pemphigoid: A case report

Pemphigoid disorders are autoimmune bullous dermatoses with a high mortality rate of up to 40 %, associated with many complications during hospitalization, even when treated with conventional therapies such as steroids, oral antibiotics, and steroid-sparing immunosuppressants. We present a continuous case monitoring a patient with a medical history of oral diabetic medication, who was diagnosed with bullous pemphigoid on December 26, 2023. Despite treatment with an immunomodulator (hydroxychloroquine), antihistamines, injectable and oral steroids, analgesics, antibiotics, and antibiotic ointment, the patient's symptoms of blisters, erosions, and ulcerations persisted severely. Consequently, Chinese Herbal Medicine (CHM) and Chinese Herbal Medicine Ointment (CHMO) were prescribed for the patient from January 5, 2024, to February 23, 2024. After the combined therapy of Chinese herbal medicine and ointment with conventional treatment, the patient's blisters, erosions, ulcerations, inflammation, and the development of new lesions were alleviated. This case suggests that an integrative approach combining Chinese herbal medicine and ointment with Western medical treatment could be a cost-effective option for improving the prognosis of bullous pemphigoid patients.

Burden of Disease of Bullous Pemphigoid: A Targeted Literature Review

BACKGROUND

Bullous pemphigoid (BP) is a rare, chronic, autoimmune, blistering disease characterized by heterogenous lesions including the formation of fluid-filled blisters on frequently flexed areas of the skin and involvement of the mucosa in 10-25% of patients. BP mainly affects older patients and is associated with increased morbidity and mortality. The aim of the targeted literature review was to assess the clinical, humanistic, and economic burden associated with BP.

SUMMARY

Targeted searches were conducted in Embase and MEDLINE for studies published in English up to November 2022 that reported burden of illness of BP. A total of 42 publications on the clinical (n = 37), humanistic (n = 6), and economic (n = 8) burden of BP were identified. BP was associated with a high mortality rate (27-72%) and an increased risk of death compared to matched controls. The majority of patients had at least one comorbidity, including hypertension, diabetes mellitus, stroke, and neurological disorders, and showed severe symptoms such as itching and pain. BP was associated with a negative impact on BP- and pruritus-related quality of life and mental health, with 31% and 38% of patients with BP experiencing depression and anxiety in the "borderline/abnormal" range, respectively. BP was further associated with high economic burden, reflected by increased healthcare resource utilization, such as longer hospital stays (7.3 days in patients with BP vs. 4.7 days in those without BP), and direct disease-related costs.

KEY MESSAGES

This review provides a detailed assessment of the evidence base for BP, characterizing key aspects of the disease burden including clinical, humanistic, and economic burden. The results emphasize that this rare disease is associated with a substantial burden to patients and have implications for clinical practice in the management of BP.

The association between bullous pemphigoid and cognitive outcomes in middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

Bullous pemphigoid (BP) is a rare autoimmune skin condition that causes large fluid-filled blisters on the skin, especially in older adults. BP has been linked to various diseases and medications, but its association with cognitive outcomes is unclear.

METHODS

We conducted a systematic review and meta-analysis of studies investigating the association between BP and cognitive outcomes, such as all-cause dementia, Alzheimer's disease, and vascular dementia in middle-aged and older adults. We searched PubMed, Embase, and Web of Science databases for relevant studies published up to March 2023. We included studies that reported odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between BP and cognitive outcomes. We pooled the ORs, or HRs using random-effects models and performed subgroup and sensitivity analyses to explore potential sources of heterogeneity.

RESULTS

The study selection process identified 13 studies for inclusion in the analysis, 11 studied arms of which used a case-control design and 7 studied arms of which used a cohort design. The studies were conducted primarily in Europe, with a few from Asia and the United States. The meta-analysis found that BP was associated with higher odds of all-cause dementia in middle-aged and older participants in both cohort studies(HR = 1.41,95% CI: 1.20-1.66, P = 0.000) and case-control (OR = 4.25, 95% CI, 2.73-6.61; P = 0.000). The study found no significant publication bias in the included studies. The meta-regression analyses identified some subgroups associated with significantly reported odds ratios in case-control association analysis, including Europe, BP diagnosed based on clinical, histology, immunofluorescence, and both adjustment status of NO and YES.

CONCLUSIONS

Our meta-analysis suggests that BP is associated with an increased risk of all-cause dementia in middle-aged and older adults. Further studies are needed to elucidate the underlying mechanisms and causal relationship between BP and cognitive outcomes.