Survey of bullous pemphigoid in an Italian university hospital: clinical-epidemiological characteristics and follow-up.

Abstract

The clinical-epidemiological characteristics and course of bullous pemphigoid in the general population is not clear. Few studies have been performed to date, and only one in the Italian population more than ten years ago. We decided to evaluate the characteristics and outcome of patients admitted for a bullous pemphigoid at our Hospital in the last 4 years. We retrospectively reviewed the last 4 years' medical records of the Department of Dermatology of the University of Bologna, identifying all patients with histological and immunological data typical for bullous pemphigoid. The patients were contacted and, whenever possible, re-evaluated clinically and serologically. Finally, we made a reviews of therapies administered in these cases. We identified 53 patients with a diagnosis of sub-epidermal autoimmune blistering disease. At re-evaluation, resolution of the disease was observed in 13 cases (24.52%) while the disease persisted in 32 cases. An improvement was observed in 35 (66.03%) patients, a worsening was observed in 3 (5.66%) patients, while the class did not change in 5 (9.43%) patients. All patients received systemic steroids as first line therapy, although most patients underwent more than one therapy. Fifteen patients received systemic steroid therapy alone, 22 patients received azathioprin, 16 patients received methotrexate, all patients received a prescription of topical steroid. Twenty-eight patients had abnormal values of eosinophilia, extremely susceptible to systemic steroid therapy. The findings of our study differ slightly from data collected by other authors in literature. Methotrexate is the drug of choice in terms of efficacy, practicality, cost and tolerability, particularly in the elderly population.