Incidence Of Bullous Pemphigoid Research Articles

ASSOCIATION BETWEEN MEDICATION USE AND BULLOUS PEMPHIGOID: A TEN-YEAR SYSTEMATIC REVIEW

Background: Bullous pemphigoid is an autoimmune subepithelial disease. It was associated with autoantibodies targeting hemidesmosome protein BPAG1 and BPAG2. The incidence of bullous pemphigoid has increased 1.9-4.3 times in the past two decades, possibly due to increased life expectancy, medication use, and improved diagnostic methods. Trigger factors of BP included drugs, physical factors, radiotherapy, trauma, and thermal exposure. The aim: This study aims to determine association between medication use and bullous pemphigoid. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 1,662 articles, whereas the results of our search on ScienceDirect brought up 1,143 articles. The results of the search conducted by title screening yielded a total of 13 articles for PubMed and 32 articles for ScienceDirect. We compiled a total of 26 papers, 8 of which came from PubMed and 18 of which came from ScienceDirect. We excluded 2 review articles, 1 duplicate article, 3 non-full text articles, and 3 articles having insufficient outcomes. In the end, we included seventeen research that met the criteria. Conclusion: Our study suggests that dipeptidyl peptidase-4 inhibitors and aldosterone antagonists are associated with BP. Other medications, such as immunomodulatory agents, anticonvulsants, tyrosine kinase inhibitors, antibiotics, anticoagulants, diuretics, and mRNA COVID-19 vaccine, may be associated with BP. Regarding these results, clinicians should pay close attention to prescribing the medicine to their patients.

Bullous Pemphigoid Associated with Aspirin Drug Reaction: A Case Report

<p>一位有橫斷性脊髓炎病史規律服用免疫抑制劑移護寧(azathioprine)的64歲男性，因心房顫動以阿斯匹靈(aspirin)治療約一年，來到門診主訴軀幹和大腿出現散佈性紅疹和水泡，經診所開立的抗生素和抗病毒藥物治療未改善，以蜂窩性組織炎診斷收治住院，隨後皮膚切片檢查證實為類天皰瘡，經評估停用阿斯匹靈並以靜脈注射類固醇治療，症狀好轉後出院，並持續接受門診追蹤。類天皰瘡為好發於70歲以上老年人的自體免疫疾病，隨著人口老化、多重共病以及可能引發此疾病的藥物增加，類天皰瘡的發病率在過去幾十年中有所增加，阿斯匹靈在病理機轉上也被指出可能引發類天皰瘡，雖然目前的系統性回顧顯示兩者之間並沒有顯著相關，但有鑒於新藥開發，藥物誘發性皮膚反應增多，若發現病人皮膚出現水泡，合併發燒、喘、低血壓、皮膚疼痛、大面積脫皮或成灰紫色，侵犯眼睛、咽喉或消化道黏膜等應立即停用可能誘發此皮膚表現的藥物，並轉介專科醫師。類天皰瘡的治療以類固醇和免疫抑制劑為主，長期使用可能增加高血壓、糖尿病、骨質疏鬆與感染等風險，病人於後續門診追蹤，基層醫師評估皮膚病灶改善狀況，以每2-3週的頻率減低藥物劑量，並根據病人的年齡和狀況安排藥物相關副作用的檢查。</p> <p> </p><p>A 64-year-old male with a history of transverse myelitis and regular use of immunosuppressive agent azathioprine presented to our outpatient clinic with a complaint of disseminated erythematous rash and blisters on the trunk and thighs. He had been treated with aspirin for atrial fibrillation for about a year. Despite treatment with antibiotics and antiviral medications prescribed by the clinic, the symptoms did not improve, and he was admitted to the hospital with a diagnosis of cellulitis. Subsequent skin biopsy confirmed the diagnosis of bullous pemphigoid. After further assessments, aspirin was discontinued, and intravenous corticosteroid therapy was initiated, leading to symptom improvement. The patient was later discharged for follow-up in the outpatient clinic. Bullous pemphigoid is an autoimmune disease that predominantly affects elderly individuals aged 70 and above. Due to multiple comorbidities and increased use of medications that may trigger this disease, the incidence of bullous pemphigoid has been on the rise in recent decades among the elderly population. Aspirin has been suggested to be a potential trigger for bullous pemphigoid in its pathophysiology. Although current systematic reviews do not show a significant association between the two, the increased development of drug-induced skin reactions with the advent of new medications warrants caution. If a patient develops blisters on the skin, along with fever, wheezing, hypotension, skin pain, extensive peeling, or a grayish-purple discoloration, or if the condition affects the eyes, throat, or gastrointestinal mucosa, the medication potentially causing this skin manifestation should be discontinued immediately, and the patient should be referred to a specialist. </p> <p> The treatment of bullous pemphigoid primarily involves steroids and immunosuppressive agents. Long-term use of these medications may increase the risk of side effects such as hypertension, diabetes, osteoporosis, and infections. After patients return to outpatient follow-up, primary care physicians should carefully assess whether the skin lesions have improved. Medication dosage should be gradually reduced with a frequency of every 2-3 weeks, and examinations for medication-related side effects should be arranged based on the patient’s age and condition.</p> <p> </p>

Bullous pemphigoid in 65 years old female: a case report

Introduction: Bullous pemphigoid is an autoimmune disorder. The incidence of bullous pemphigoid has increased over time, current understanding regarding treatment and complication is an important issue considering the disease often occur in elderly resulting in high rates of morbidity to the patients.
 Objective: Aim of the current case report is to describe the clinical relevance regarding symptom and treatment of bullous pemphigoid.
 Case report: A 65 years old female patient, came with chief complaints of bullae in the abdominal region with itching and burning sensation in the ruptured bullae. Over time bullae spread in the lower and upper extremity. The patient was admitted for four days with therapy intravenous steroids, an oral antihistamine, and potent topical steroids. The patient was discharged from hospital in good condition.
 Conclusion: Bullous pemphigoid is an inflammatory autoimmune skin disease and usually result in good prognosis with adequate management.

Incidence of bullous pemphigoid and risk of mortality in the dialysis population: A retrospective cohort study

To the Editor: Bullous pemphigoid (BP) is a blistering disease caused by autoantibodies to BP antigens 230 and 180. Incidence in the United States has been reported as 2.4 per 100,0001; incidences in the European literature range from 1.3 to 7.6 per 100,000.2,3 The primary outcome of the current study was to determine incidence of BP, stratified by age, in the United States dialysis population and compare the incidence to the general population. A secondary outcome was to determine if BP was a risk factor for mortality.

Global incidence and prevalence of bullous pemphigoid: A systematic review and meta-analysis.

Integrated information on the global prevalence and incidence of bullous pemphigoid (BP) is lacking. To estimate the incidence and prevalence of BP in a systematic review and meta-analysis. Observational studies were included by using databases of Medline, EMBASE, and Cochrane Library. Subgroup analysis was by continent, age, sex, and country income level. Random-effects model was used. Between-study heterogeneity was assessed using the I2 statistic. The global incidence was 0.0419 per 1000 person-years (95% CI: 0.0414-0.0424). The incidence was 0.047 per 1000 person-years (95% CI: 0.0462-0.0477), 0.0419 per 1000 person-years (95% CI: 0.0411-0.0426), 0.0072 per 1000 person-years (95% CI: 0.0067-0.0078), 0.003 per 1000 person-years (95% CI: 0.0023-0.0039) in North America, Europe, Asia, and Africa, respectively; 0.0202 per 1000 person-years (95% CI: 0.0196-0.0208) and 0.0181 per 1000 person-years (95% CI: 0.0175-0.0188) females and males; 0.001 per 1000 person-years (95% CI: 0.001-0.001), 0.002 per 1000 person-years (95% CI: 0.001-0.002), 0.004 per 1000 person-years (95% CI: 0.004-0.004); 0.007 per 1000 person-years (95% CI: 0.007-0.008), 0.011 per 1000 person-years (95% CI: 0.011-0.012), 0.017 per 1000 person-years (95% CI: 0.015-0.018) for age <50, 50-59, 60-69, 70-79, 80-89, and ≥90years; 0.0038 per 1000 person-years (95% CI: 0.0036-0.004112) (I2 =99%, p<.05) and 0.0456 per 1000 person-years (95% CI: 0.0450-0.0462) (I2 =100%, p<.05). The pooled clinic-based prevalence was 0.79% (95% CI: 0.75%-0.84%), 1.13% (95% CI: 1.06%-1.21%), 0.21% (95% CI: 0.17%-0.26%), and 0.13% (95% CI: 0.1%-0.15%) for Asia, Africa, and Europe. This study identified the global incidence and prevalence of BP in terms of spatial and population distributions and among various income level. A relatively higher incidence was in Europe, females, older people, and high-income level country. The prevalence was higher in Asia. These findings should be interpreted with caution due to high heterogeneity of included studies.

The association between statins and subsequent risk of bullous pemphigoid: A population-based cohort study

The association between statins and subsequent risk of bullous pemphigoid: A population-based cohort study

Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases.

Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3years)], 83% were patients with bullous pemphigoid [n=56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.

Incidence of Bullous Pemphigoid and Pemphigus in Korea.

Incidence of Bullous Pemphigoid and Pemphigus in Korea.

Bullous pemphigoid associated with the use of dipeptidil peptidase-4 inhibitors: analysis from studies based on pharmacovigilance databases

Background Bullous pemphigoid has been associated to dipeptidase-4 inhibitors. Objectives Addressing the potential Bullous pemphigoid-dipeptidase-4 inhibitors association based on pharmacovigilance data currently available in Spain in order to obtain a composite disproportionality estimator from all the data generated by the case-non case studies conducted to this date. Setting The Spanish Pharmacovigilance System for Human Use Drugs database. Method Case-non case study based on the Spanish Pharmacovigilance System for Human Use Drugs notifications submitted between 2007 and 2018 (n = 169,280), using the Medical Dictionary for Regulatory Activities term (Preferred Term) ‘pemphigoid’ for sitagliptin, vildagliptin, saxagliptin, linagliptin, and alogliptin (n = 1952). As negative control, we used acetaminophen, while furosemide was the positive control. A pooled reported odds ratio analysis in the French, Japanese, and Spanish national pharmacovigilance databases was performed. On The Spanish Pharmacovigilance System for Human Use Drugs, we conducted a bullous pemphigoid-metformin association analysis within the period 1982–2018. Main outcome measure Adverse reaction cases in pharmacovigilance databases and the disproportionality through the reporting odds ratio. Results Within The Spanish Pharmacovigilance System for Human Use Drugs, we found 45 cases of bullous pemphigoid in dipeptidase-4 inhibitors patients. Median age was 77 years (range 72–82). The median latency period was 7 months (range 0.23–86). The Bullous pemphigoid-dipeptidase-4 inhibitors association was established with a reporting odd ratio = 70.0 (95% confidence intervals 49.1–10.1). In the combined analysis of the three aforementioned pharmacovigilance databases, the pooled reporting odd ratio was 81.0 (95% confidence intervals 69.5–94.4). Conclusion The composite estimator for the three national pharmacovigilance databases yields clear evidence of a Bullous pemphigoid-dipeptidase-4 inhibitors association, which was statistically significant for both the pharmacological class as a whole and each of the dipeptidase-4 inhibitors agents under investigation. Metformin’s role in the incidence of bullous pemphigoid appeared casual rather than causal. No differences between Caucasian and Asian populations were noted.

Bullous pemphigoid in 65 years old female: a case report

Introduction: Bullous pemphigoid is an autoimmune disorder. The incidence of bullous pemphigoid has increased over time, current understanding regarding treatment and complication is an important issue considering the disease often occur in elderly resulting in high rates of morbidity to the patients. Aim of current case report is to describe the clinical relevance regarding symptom and treatment of bullous pemphigoid.Case presentation: A 65 years old female patient, came with chief complaints of bullae in abdominal region with itching and burning sensation in the ruptured bullae. Over time bullae spread in lower and upper extremity. Patient was admitted for four days with therapy intravenous steroids, oral antihistamine, and potent topical steroids. Patient was discharged from hospital in well condition.Conclusion: Bullous pemphigoid is an inflammatory autoimmune skin disease and usually result in good prognosis with adequate management.Keywords: autoimmune, bullous, pemphigoid, skin, disease.

Comorbidities of bullous pemphigoid in a Finnish cohort.

The incidence of bullous pemphigoid (BP) is increasing in Finland. To investigate the clinical presentation, comorbidities, and medications in a cohort of Finnish patients with confirmed BP managed in a university hospital setting. An observational retrospective study of all consecutive patients diagnosed with BP in 2012-2013 at the Department of dermatology, HUCH. The prevalence of the most common comorbidities was compared to that in a sample population aged over 30 years. Seventy patients were included (mean age: 77 years at diagnosis). The most common comorbidities were hypertension (44%), type 2 diabetes (34%), and ischaemic heart disease (26%). Almost half of the cohort had a neurological condition (46%). A statistically significant association was identified between BP and a past history of malignancies (17%; p<0.001), type 2 diabetes (24%; p<0.001), and chronic obstructive lung disorder (COPD) (10%; p=0.004), compared to an age-matched control group. The most common standard drugs were statins, beta-blockers, and diuretics. In total, 83% of the patients with type 2 diabetes took anti-diabetic treatments, mainly metformin (80%) and gliptins (55%). Significant associations were identified between BP and COPD, type 2 diabetes, and a past history of malignancy, compared to the general population. In this study, the specific role of some medications, such as gliptins, may account for the onset of BP in diabetic type 2 patients.

Incidence of Bullous Pemphigoid in Southern Part of Miyagi Prefecture

Incidence of Bullous Pemphigoid in Southern Part of Miyagi Prefecture

Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009

Bullous pemphigoid (BP) is an autoimmune blistering disease that is associated with increased mortality. We sought to determine the incidence and mortality of patients with BP. A total of 87 residents of Olmsted County, Minnesota, were identified who had their first lifetime diagnosis of BP from January 1960 through December 2009. Incidence and mortality were compared with age- and sex-matched control patients from the same geographic area. The adjusted incidence of BP was 2.4 per 100,000 person-years (95% confidence interval, 1.9-2.9). Incidence of BP increased significantly with age (P < .001) and over time (P= .034). Trend tests indicate increased diagnosis of localized disease (P= .006) may be a contributing factor. Survival observed in the incident BP cohort was significantly poorer than expected (P < .001). Survival was not different among patients with multisite versus localized disease (P= .90). Retrospective study design and study population from a small geographic area are limitations. Incidence of BP in the United States is comparable with that found in Europe and Asia. The mortality of BP is lower in the United States than Europe, but higher than previous estimates.

Les maladies bulleuses auto-immunes

Autoimmune blistering diseases are characterized by the production of pathogenic autoantibodies that are responsible for the formation of epidermal blisters. Major advances in the understanding of the pathogenesis of these disorders have allowed the development of new therapeutic agents. Recent epidemiologic data showed that bullous pemphigoid mainly affects elderly patients. Bullous pemphigoid is often associated with degenerative neurologic disorders. A major increase in the incidence of bullous pemphigoid has been observed in France. Treatment of bullous pemphigoid is mainly based on superpotent topical corticosteroids. The role of desmosomal proteins has been demonstrated in the initiation, propagation and persistence of the autoimmune response in pemphigus. Several studies have shown a correlation between anti-desmoglein antibody titers and disease activity. Pemphigus susceptibility genes have been identified. Oral corticosteroids remain the mainstay of pemphigus treatment. Dramatic and long-lasting improvement has been recently obtained with rituximab in recalcitrant types of pemphigus. Other autoimmune junctional blistering diseases are rare entities, whose prognosis can be severe. Their diagnosis has been improved by the use of new immunological assays and immunoelectronic microscopy. Immunosupressants are widely used in severe types in order to prevent mucosal sequelae.

Risk Factors for Bullous Pemphigoid in the Elderly: A Prospective Case–Control Study

A rise in the incidence of bullous pemphigoid (BP) was documented recently in Europe, and the main risk factors for BP remain unknown. We conducted a multicenter case-control study to evaluate risk factors for BP. We identified 201 incident BP cases and 345 controls individually matched for age, gender, center, and place of residence (home, nursing home, or extended-care facility). We used univariate and multivariate logistic regression analyses to compare drugs used for over 3 months, comorbidities, and physical and cognitive impairments between cases and controls. Mean age of BP patients was 84.2 (±8.7) years. Factors independently associated with BP by multivariate analysis were major cognitive impairment (odds ratio (OR), 2.19; 95% confidence interval (95% CI), 1.24-3.87), bedridden condition (OR, 2.19; 95% CI, 1.23-3.89), Parkinson's disease (OR, 2.16; 95% CI, 1.09-4.27), unipolar or bipolar disorder (OR, 5.25; 95% CI, 1.21-22.86), and chronic use of spironolactone (OR, 2.30; 95% CI, 1.20-4.46) or phenothiazines with aliphatic side chains (OR, 3.70; 95% CI, 1.21-11.34). Chronic analgesic use was associated with a lower risk of BP (OR, 0.49; 95% CI, 0.30-0.81). Thus, risk factors for BP include neurological disorders, particularly dementia and Parkinson's disease, psychiatric disorders (unipolar and bipolar disorders), bedridden condition, and chronic use of several drugs.

Incidence of bullous pemphigoid and pemphigus in Switzerland: a 2-year prospective study

Bullous pemphigoid (BP), pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune bullous diseases characterized by the presence of tissue-bound and circulating autoantibodies directed against disease-specific target antigens of the skin. Although rare, these diseases run a chronic course and are associated with significant morbidity and mortality. There are few prospective data on gender- and age-specific incidence of these disorders. Our aims were: (i) to evaluate the incidence of BP and PV/PF in Swiss patients, as the primary endpoint; and (ii) to assess the profile of the patients, particularly for comorbidities and medications, as the secondary endpoint. The protocol of the study was distributed to all dermatology clinics, immunopathology laboratories and practising dermatologists in Switzerland. All newly diagnosed cases of BP and pemphigus occurring between 1 January 2001 and 31 December 2002 were collected. In total, 168 patients (73 men and 95 women) with these autoimmune bullous diseases, with a diagnosis based on clinical, histological and immunopathological criteria, were finally included. BP showed a mean incidence of 12.1 new cases per million people per year. Its incidence increased significantly after the age of 70 years, with a maximal value after the age of 90 years. The female/male ratio was 1.3. The age-standardized incidence of BP using the European population as reference was, however, lower, with 6.8 new cases per million people per year, reflecting the ageing of the Swiss population. In contrast, both PV and PF were less frequent. Their combined mean incidence was 0.6 new cases per million people per year. CONCLUSIONS; This is the first comprehensive prospective study analysing the incidence of autoimmune bullous diseases in an entire country. Our patient cohort is large enough to establish BP as the most frequent autoimmune bullous disease. Its incidence rate appears higher compared with other previous studies, most likely because of the demographic characteristics of the Swiss population. Nevertheless, based on its potentially misleading presentations, it is possible that the real incidence rate of BP is still underestimated. Based on its significant incidence in the elderly population, BP should deserve more public health concern.

Bullous pemphigoid and pemphigus vulgaris—incidence and mortality in the UK: population based cohort study

Objective To determine the incidence of and mortality from bullous pemphigoid and pemphigus vulgaris in the United Kingdom.Design Retrospective historical cohort study.Setting Computerised medical records from the health improvement network,...

BULLOUS DISEASES IN MALAYSIA: EPIDEMIOLOGY AND NATURAL HISTORY

The characteristics of three primary bullous diseases, pemphigus, pemphigoid, and dermatitis herpetiformis, seen in this country, probably reflecting this region, are discussed and compared to those reported in the literature in the West. One hundred and forty-eight patients with bullous diseases were seen over a period of 15 years. The criteria for confirmation of clinical diagnosis were the findings of the direct immunofluorescent test. Pemphigus vulgaris was the commonest bullous disease. The incidence of bullous pemphigoid was highest in the Indians of Malaysian origin, and they are also more likely to develop pemphigus vulgaris than any other ethnic group. Linear IgA type formed the entire group of dermatitis herpetiformis. The granular type was not seen at all. The patients were treated with prednisolone alone or together with methotrexate or azathioprine. Dapsone alone controlled the dermatitis herpetiformis. The known association between pemphigus and other diseases with immunologic disturbances was not found in this study. The natural history of the bullous disease as seen in the follow-up patients is described. Deaths in pemphigus and pemphigoid were more due to either complications of steroid therapy or unassociated diseases than the primary disease itself. Introduction of immunofluorescence as a diagnostic tool in pemphigus and extension of this facility to other bullous diseases has led to detailed characterization of these diseases as seen in the West; however, publications in English dealing with epidemiologic aspects of bullous diseases in this region are rare.(ABSTRACT TRUNCATED AT 250 WORDS)