Diabetes mellitus and hyperglycemic complications in bullous pemphigoid

Chai, Zi Teng; Tan, Colin; Liau, May MeiQi; Kaur, Harsharon; Pang, Shiu Ming; Phoon, Yee Wei; Chandran, Nisha Suyien; Lee, Haur Yueh

doi:10.1016/j.jaad.2019.11.018

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…According to a study from Chai et al., 19 their findings highlight the substantial burden of hyperglycemic complications in BP patients, with nearly 40% of individuals experiencing such issues. This underscores the importance of proactive glycemic monitoring and management in BP patients, particularly those with pre‐existing DM or other risk factors like obesity, hypertension, chronic renal failure, and hyperlipidemia.…”

Section: Discussionmentioning

confidence: 99%

Bullous pemphigoid and diabetes mellitus: a systematic review and meta‐analysis

Jiirasutat,

Pongchareon,

Weschawalit

2024

Int J Dermatology

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We aimed to systematically review and meta‐analyze the association between diabetes mellitus (DM) and bullous pemphigoid (BP). Bullous pemphigoid (BP) is a prevalent autoimmune subepidermal blistering disease. Comorbid health conditions like neurological diseases and malignancies have been associated with BP. Growing evidence suggests that type 2 diabetes mellitus (T2DM) may increase the risk of developing BP. This review aims to synthesize this evidence. A systematic literature review was performed using Medline, PubMed, and Scopus in March 2022. Studies exploring the association between BP and DM were included. Data were extracted, and quality was assessed using the Newcastle–Ottawa scale. Meta‐analysis was conducted to identify the odds ratio (OR) and 95% confidence intervals (CI) of the association. Seventeen studies were included, most being case–control studies from Europe and Asia. The pooled OR was 2.06 (95% CI: 1.61–2.62), suggesting a significant association between DM and BP. However, strong heterogeneity (I2 = 88%) was observed. Evidence consolidates a significant relationship between DM and BP, potentially due to alterations in the immune system and skin properties caused by diabetes. Strengths of this review include a comprehensive search, rigorous methodology, large sample size, and heterogeneity evaluation. However, varying study quality, potential publication bias, and unaccounted confounding factors present limitations. There is a potential link between T2DM and an increased risk of BP. Further studies are required to understand this association and the underlying mechanisms.

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Section: Discussionmentioning

confidence: 99%

Bullous pemphigoid and diabetes mellitus: a systematic review and meta‐analysis

Jiirasutat,

Pongchareon,

Weschawalit

2024

Int J Dermatology

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“…multiple sclerosis, dementia, Parkinson’s disease, epilepsy, stroke), as well as cardiovascular diseases (e.g. diabetes, hypertension, pneumonia, pulmonary embolism), have an increased prevalence among patients with BP [ 2 , 8 – 10 ]. In a retrospective cohort study involving 335 BP patients there was no significant difference in malignancy rates between BP patients and the general population [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Advancements in Bullous Pemphigoid Treatment: A Comprehensive Pipeline Update

Karakioulaki,

Eyerich,

Patsatsi

2023

Am J Clin Dermatol

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Abastract Bullous pemphigoid (BP) is a common autoimmune bullous disease affecting mainly the elderly, with rising incidence due to increased life expectancy. This disease is characterized by tense bullous lesions on normal or erythematous skin, accompanied by pruritus. BP pathogenesis involves autoantibodies against hemidesmosomal proteins BP180 and BP230, leading to detachment at the dermo-epidermal junction as well as blister formation. BP is associated with coexisting comorbidities and drug exposure, and its management often requires high doses or chronic use of systemic glucocorticoids, posing risks of adverse effects. This review focuses on novel treatment options for BP, exploring therapies targeting different immune pathways. Rituximab, a CD20 monoclonal antibody, depletes B-lymphocytes and has shown efficacy in severe cases. Dupilumab, targeting interleukin (IL)-4 receptor α and thus blocking IL-4 and IL-13, downregulates type 2 helper (Th2) responses and has demonstrated promising results. Targeting eosinophil-related molecules using bertilimumab and AKST4290 has yielded positive results in clinical trials. Omalizumab, an immunoglobulin (Ig) E antibody, can reduce disease severity and allows corticosteroid tapering in a number of cases. Complement inhibitors such as nomacopan and avdoralimab are being investigated. IL-17 and IL-23 inhibitors such as secukinumab and tildrakizumab have shown potential in a limited number of case reports. Neonatal Fc receptor antagonists such as efgartigimod are under investigation. Additionally, topical therapies and Janus kinase inhibitors are being explored as potential treatments for BP. These novel therapies offer promising alternatives for managing BP, with potential to improve outcomes and reduce high cumulative doses of systemic corticosteroids and related toxicities. Further research, including controlled clinical trials, is needed to establish their efficacy, safety, and optimal dosing regimens for BP management.

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“…Bullous pemphigoid (BP) affects predominantly elderly patients, and the disease incidence rises exponentially with age. A high prevalence of diabetes mellitus (DM) in patients with BP has been noticed, ranging from 20 to 30% [ 1 ].…”

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confidence: 99%