Epidemiology and Co-morbidities of Bullous Pemphigoid: A Retrospective Study

INTRODUCTION:
Bullous pemphigoid is the most common autoimmune subepidermal bullous dermatosis which is most commonly seen in the elderly population. The disease has two phases: non bullous and bullous. The bullous phase is diagnostic: with tense vesicles or bullae on erythematous or healthy skin; appearing symmetrically on the lower trunk, flexor aspect of the extremities and the abdomen. The diagnosis of bullous pemphigoid is confirmed by biopsy from the lesions, perilesional direct immunofluorescence, indirect immunofluorescence from the patient’s sera and immunoblotting. Treatment methods include systemic and topical corticosteroids; doxycycline; dapsone; methotrexate; azathioprine; mycophenolic acid; intravenous immunoglobulin; rituximab and omalizumab. Bullous pemphigoid was confirmed to be associated with neurologic and psychiatric disorders; however, it is not associated with malignancies.
METHODS: The aim of this study is to determine the female-to-male ratio and the mean ages of diagnoses; disease durations and co-morbidities separately in the female and male Turkish patient groups. In this descriptive study, the patient files of bullous pemphigoid patients who applied to the İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Dermatology Department Blistering Diseases Outpatient Clinic between the years 1999 and 2019 were evaluated retrospectively. The gender, the age at the time of diagnosis, the disease duration and co-morbid diseases of each patient were noted.
RESULTS: For the 58 patients included in this study the female-to-male ratio was 1.42. The average age of diagnosis was 73.79 years; the oldest patient was 103 years old and the youngest patient was 15 years old. The average disease duration was 104.9 months; the longest being 264 months and the shortest being one month. As for the co-morbidities, the most commonly observed ones were, in decreasing frequency, hypertension, diabetes mellitus, coronary artery diseases, chronic kidney disease and osteoporosis.
DISCUSSION AND CONCLUSION: Bullous pemphigoid has a female predominance and is usually diagnosed during the seventh decade; Bullous pemphigoid is associated with cardiac diseases, diabetes mellitus, neurologic and psychiatric diseases. This study showed an association between bullous pemphigoid and cardiac diseases or diabetes mellitus. However, the results failed to show an association with neurologic or psychiatric diseases. Bullous pemphigoid is not associated with malignancies; similarly, this study did not find a significant prevalence of history of malignant neoplasms in bullous pemphigoid patients.