Skin Eosinophil Counts in Bullous Pemphigoid as a Prognostic Factor for Disease Severity and Treatment Response

Abstract

Dermal infiltration of eosinophils and eosinophilic spongiosis are prominent features of bullous pemphigoid lesions. Although several observations support the pathogenic role of eosinophils in bullous pemphigoid, few studies have examined the impact of skin eosinophil counts on disease severity and treatment response. This retrospective study assessed the association between eosinophil counts in skin biopsy samples of 137 patients with bullous pemphigoid and their demographic characteristics, comorbidities, disease severity, and treatment response. There was no relationship between eosinophil count and age, sex, or disease severity at disease onset. There was a positive relationship between eosinophil counts and neurological comorbidity and a negative relationship between eosinophil counts and treatment response. At all follow-up points patients with no tissue eosinophils had a better response to treatment than patients with any tissue eosinophil count. In conclusion, skin eosinophil counts in patients with bullous pemphigoid are not correlated with disease severity at onset, but can serve as a negative prognostic marker for treatment response.

Eosinophils, Basophils, and Neutrophils in Bullous Pemphigoid

“…The authors conclude that eosinophils may be used as a marker to predict disease severity in patients with BP [54]. The association between the amount of eosinophils in skin biopsy samples of 137 patients with BP and their demographic characteristics, comorbidities, disease severity, and treatment response was also evaluated in a very recently published retrospective study by Baum et al [55]. Contrarily, they found no correlations between eosinophil numbers and disease severity, but their quantity may serve as a prognostic factor for treatment outcome.…”

Dupilumab effectively and rapidly treats bullous pemphigoid by inhibiting the activities of multiple cell types

“…Toxic granule proteins (eosinophil cationic protein [ECP], major basic protein [MBP], or eosinophil peroxidase [EPO]) and a cytokine (matrix metalloproteinase 9 [MMP9])released by eosinophils promote keratinocyte separation (6). Eosinophil counts, which fall on corticosteroid treatment, correlate with BP activity and may be prognostic in certain patients (14,15). In addition, the plasma level of thymus and activation regulated chemokine (TARC), an important Th2 chemotactic agent, correlated positively with the Bullous Pemphigoid Disease Area Index (BPDAI) score of patients on systemic corticosteroids (16).…”