Bullous Pemphigoid as Pruritus in the Elderly

Abstract

Itch without skin lesions can be the only symptom of bullous pemphigoid. Therefore, it is important to include serologic and direct immunofluorescence in the diagnostic algorithm of itch. We propose the unifying term pruritic nonbullous pemphigoid for all patients with immunopathologic findings of bullous pemphigoid, itch, and no blisters.

Pruritus Epidemiology and Quality of Life

“…In elderly patients with xerosis, 30-60 % experience pruritus (Beauregard and Gilchrest 1987). Another common cause of pruritus is urticaria, which has a lifetime prevalence of 15-20 % in the general population (Soter 1998;Bakker et al 2013). In patients with psoriasis involving more than 30 % of their skin, 80 % experience itch (Yosipovitch et al 2000;Krueger et al 2001).…”

“…Contact dermatitis, keloids, and scars are also associated with itch, but the prevalence of itch in these conditions is unknown (Herman 1994;. Rare skin diseases are also anecdotally reported with pruritus as a significant symptom such as bullous pemphigoid (Bakker et al 2013), dermatitis herpetiformis (Powell et al 2004;Passe et al 2008), and lichen planus (Welz-Kubiak and Reich 2013). However, epidemiologic studies in such rare entities are very difficult to perform.…”

Toward a Practical Renaming of Bullous Pemphigoid and All Its Variants

“…Hence, the adjective "bullous" should not be used to designate the blistering in pemphigoid; the suggested designation of pruritic nonbullous pemphigoid for a subset of patients does not lead to more clarity. 1 We propose replacing bullous pemphigoid with the term cutaneous pemphigoid, a term with broader catchment in the spectrum of clinical BP presentations and with implications that the involvement of mucous membrane sites, while possible in up to 20% of cases, 5 is not predominant.…”

Underrecognition of the Heterogeneous Clinical Spectrum of Bullous Pemphigoid

“…A common feature of all clinical pemphigoid variants is a pronounced pruritus, which recently has been included as a diagnostic criterion of pemphigoid. 3 As stated in the article by Bakker et al, 2 propose the term pruritic nonbullous pemphigoid to distinguish it from classic BP. 2 We propose to rule out cases of nonbullous BP by direct immunofluorescence, indirect immunofluorescence, and ELISA whenever possible.…”

“…3 As stated in the article by Bakker et al, 2 propose the term pruritic nonbullous pemphigoid to distinguish it from classic BP. 2 We propose to rule out cases of nonbullous BP by direct immunofluorescence, indirect immunofluorescence, and ELISA whenever possible. A second, increasingly significant practice gap is the occasional detection of anti-BP230 and/or anti-BP180 IgG and, rarely, IgE in elderly patients with pruritic disorders who never had blisters.…”