The association between bullous pemphigoid and neurological disorders: a systematic review

Milani‐Nejad, Nima; Zhang, Myron; Kaffenberger, Jessica

doi:10.1684/ejd.2017.3066

Cited by 36 publications

(32 citation statements)

References 81 publications

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“…BP antigens have been identified in brain and neuronal tissue [ 18 , 19 ] and high levels of autoantibodies against BP antigens have been found in individuals affected by other neurological disorders [ 20 – 22 ]. Significant associations have been reported between BP and neurological diseases [ 23 , 24 ] and even if mechanisms underlying this association are unclear, brain-reactive antibodies have been detected in the sera of individuals with BP, which might account for the association [ 22 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

et al. 2020

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Background Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. Methods This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. Results Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92–1.85-1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04–1.54). Similar results emerged with ABD. Conclusion Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

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Section: Introductionmentioning

confidence: 99%

Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

et al. 2020

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“…Several co-morbidities accompany elderly BP patients, and neurological disorders are one of them [ 29 ]. The mean time interval by which neurological disorder precedes BP is 6.7 years, as observed in one of the systematic reviews [ 30 ]. Patients of BP are more likely to develop multiple sclerosis as neurological co-morbidity [ 29 ], while other commonly observed are dementia and Parkinson's disease [ 29 ].…”

Section: Reviewmentioning

confidence: 99%

“…The neurological disorder thus appears as a significant prognostic factor in patients of BP. Many studies calculate PD to be three times more likely to be seen in patients suffering from BP than the general population [ 29 , 30 ]. A meta-analysis by Lai YC et al states that the patients of BP are more likely to have a neurological disorder, and among that for PD, Relative Risk (RR) = 3.42, 95% CI: 3.01-3.8 [ 29 ].…”

Section: Reviewmentioning

confidence: 99%

Parkinson’s Disease and Its Dermatological Associations: Is Your Skin Whispering You a Diagnosis?

Shah

Sagar

Alhumaidi

et al. 2020

Cureus

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Parkinson's disease (PD) is a neurodegenerative disease characterized clinically by the triad of resting tremor, rigidity, and bradykinesia. Although PD is primarily known for motor disturbance, 98.6% of patients experience one or more non-motor symptoms at all stages of the disease. Dermatological disorders are discussed as common non-motor associations of PD since the 20th century. Many studies have shown that patients of PD are predisposed to skin disorders. This article is a traditional review done to analyze the association between PD and its dermatological manifestations. We did a literature search using six keywords in the PubMed database and took the relevant articles published in the last 10 years. We reviewed more than 100 articles, which also included animal studies. On meticulous review, we observed an increased incidence of certain skin disorders like seborrheic dermatitis, bullous pemphigoid, rosacea, and melanoma in patients of PD. These disorders share either common risk factors or underlying mechanisms revolving around genetics, immunology, inflammation, and pathophysiology of PD, but the exact causation yet seems obscured. We believe that this opens a horizon for more research in the link between the skin and nervous system. We also emphasize that the dermatologists, neurologists and general physicians should address the cutaneous disorders in PD timely, educate their patients, help them lessen the psychosocial distress, and improve their quality of life.

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“…Individuals were de ned as having diabetes if there were at least three diagnosis codes (ICD-9-CM: 250) in their outpatient clinic records or one in their admission record, and if they had at least 3-months of anti-diabetic medications. To avoid confounding and to investigate the impact of DPP4i on BP, we excluded diabetic patients with cancers and neurological diseases, including cerebrovascular diseases, dementia, Alzheimer's disease, Parkinson's disease, epilepsy, multiple sclerosis, and psychiatric diseases, which are well-known risk factors for BP [28,29].…”

Section: Study Populationmentioning

confidence: 99%

Association between dipeptidyl peptidase-4 inhibitors and risk of bullous pemphigoid in patients with diabetes: A population-based cohort study

et al. 2020

Preprint

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Abstract Background Higher bullous pemphigoid (BP) risk has been reported to be associated with dipeptidyl peptidase 4 inhibitor (DPP4i). However, large-scale studies to investigate the association between BP and DPP4i treatment are limited. The aim of this study is to examine the association between BP risk and DPP4i treatment in diabetes patients. Methods We conducted a nationwide cohort study based on the Taiwan National Health Insurance Database between 2000 and 2015. 124,619 diabetic patients who were receiving DPP4i therapy were matched 1: 1 with diabetic patients who had never received DPP4i by age, sex, duration of diabetes, insulin usage, and propensity score-matching of comorbidities. Results Of the 124,619 diabetes patients in the two groups, the mean age at diabetes diagnosis was 52.4 ± 10.9 years, with a mean duration of diabetes of 6.0 ± 3.9 years. After adjusting for competing mortality risk, the 6-year cumulative incidence of BP in the DPP4i-treated cohort was significantly higher than that in the non-DPP4i group (0.74 per 1000; 95% confidence interval [CI]: 0.51–1.05 vs 0.38 per 1000; 95% CI: 0.26–0.53, P = .001). The DPP4i and insulin-treated group had the highest 6-year cumulative incidence for BP (0.93; 95% CI: 0.54–1.54 per 1000). Modified Cox regression analysis revealed that DPP4i treatment (HR: 2.15, 95% CI: 1.18–3.91, P = 0.01), age (HR: 1.06, P < .001), renal disease (HR: 2.32, P < .001), and metformin user (HR: 1.93, P = 0.006) were associated with increased BP risk. Conclusion DPP4i users had a 2.2-fold increase in the risk of BP, and the risk was the highest in those with concomitant use of DPP4i and insulin. The use of DPP4is as anti-diabetic medications must be monitored carefully and may be replaced by other anti-diabetic medications in BP patients.

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The association between bullous pemphigoid and neurological disorders: a systematic review

Cited by 36 publications

References 81 publications

Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

Parkinson’s Disease and Its Dermatological Associations: Is Your Skin Whispering You a Diagnosis?

Association between dipeptidyl peptidase-4 inhibitors and risk of bullous pemphigoid in patients with diabetes: A population-based cohort study

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