Abstract
Bullous pemphigoid (BP), the most frequent blistering dermatosis in the elderly, is associated with increased mortality. The severity of BP can be assessed by detecting the anti-BP180 immunoglobulin G (IgG) concentration, but the lab test is not available in many community clinics. BP patients are usually in a hypercoagulable state with increased levels of D-dimer and fibrin degradation products (FDPs). We aimed to evaluate the use of D-dimer and FDPs in assessing BP severity. We compared the levels of plasma D-dimer, plasma FDPs, eosinophil counts, eosinophil cationic protein, and serum anti-BP180 IgG concentration between 48 typical BP patients and 33 Herpes zoster (HZ) patients (control group). Correlational analyses were conducted to determine the relationships between the lab values and common BP severity markers. The plasma D-dimer and FDP levels were higher in BP patients than in HZ controls (D-dimer: 3297 ± 2517 µg/L vs. 569.70 ± 412.40 µg/L; FDP: 9.74 ± 5.88 mg/L vs. 2.02 ± 1.69 mg/L, respectively, P < 0.0001). Significant positive correlations were found between D-dimer/FDP levels and BP severity markers (i.e. anti-BP180 IgG concentration [D-dimer: r = 0.3928, P = 0.0058; FDP: r = 0.4379, P = 0.0019] and eosinophil counts [D-dimer: r = 0.3625, P = 0.0013; FDP: r = 0.2880, P = 0.0472]) in BP patients. We also found an association between FDP and urticaria/erythema lesions (r = 0.3016, P = 0.0372), but no other BPDAI components. In 19 BP patients with complete remission after systemic glucocorticoid treatment, D-dimer and FDP levels decreased post-therapy (D-dimer: 5559 ± 7492 µg/L vs. 1738 ± 1478 µg/L; P < 0.0001; FDP: 11.20 ± 5.88 mg/L vs. 5.13 ± 3.44 mg/L; P = 0.0003), whereas they did not in BP patients with treatment resistant. Plasma D-dimer and FDP are convenient markers to evaluate BP severity assistant on BPDAI and eosinophil counts. FDP is also helpful for inflammatory lesions in BP patients.
Highlights
Bullous pemphigoid (BP), the most frequent blistering dermatosis in the elderly, is associated with increased mortality
Since BP patients are often in a hypercoagulable state with elevated levels of -dimer and FDP levels decreased post-therapy (D-dimer) and F DP15, we investigated whether plasma D-dimer and fibrin degradation products (FDPs) levels of BP patients before treatment could be used to assess BP severity
The higher frequency of hypercoagulable states in BP patients promotes us to explore the potential role of D-dimer and FDP in BP severity evaluation
Summary
Bullous pemphigoid (BP), the most frequent blistering dermatosis in the elderly, is associated with increased mortality. We compared the levels of plasma D-dimer, plasma FDPs, eosinophil counts, eosinophil cationic protein, and serum anti-BP180 IgG concentration between 48 typical BP patients and 33 Herpes zoster (HZ) patients (control group). Significant positive correlations were found between D-dimer/FDP levels and BP severity markers (i.e. anti-BP180 IgG concentration [D-dimer: r = 0.3928, P = 0.0058; FDP: r = 0.4379, P = 0.0019] and eosinophil counts [D-dimer: r = 0.3625, P = 0.0013; FDP: r = 0.2880, P = 0.0472]) in BP patients. Age > 18 years old Availability of recent coagulation test results Clinically significant subepidermal blisters ≥ 5 mm in diameter (defined as cutaneous blisters or ruptured blisters with a flexible roof covering a moist base) Dermal-epidermal separation surrounded by eosinophils on pathology Anti-BP180 ≥ 9 U/mL Immunofluorescence showed IgG and/ or C3 deposit No systemic glucocorticoid treatment before admission. A history of Vascular disease (e.g., deep venous thrombosis and aortic dissection) Anticoagulation therapy Abnormal liver and kidney function Cardiovascular disease Diabetes mellitus Cerebrovascular disease Acute or chronic inflammatory disease Malignancy with or without treatment
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