The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

Kridin, Khalaf; Ludwig, Ralf J.

doi:10.3389/fmed.2018.00220

Cited by 184 publications

(186 citation statements)

References 105 publications

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“…Bullous pemphigoid is the most common AIBD, accounting for two‐thirds of all subepidermal blistering diseases, with a yearly incidence ranging from 2.5 to 42.8/million . In Germany the prevalence of BP was reported as 259 per million population . The increased incidence of BP overtime may be attributable to an ageing population, increase in the number of neurological diseases and use of triggering medications.…”

Section: Bullous Pemphigoidmentioning

confidence: 99%

“…The increased incidence of BP overtime may be attributable to an ageing population, increase in the number of neurological diseases and use of triggering medications. BP is typically a disease of the elderly, with the highest incidence after the age of 90, and a mean presentation between 66 and 83 years . The annual incidence of BP in a population over 85 has been reported as high as 507/million .…”

Section: Bullous Pemphigoidmentioning

confidence: 99%

“…Dipeptidyl‐peptidase IV inhibitors are antihyperglycaemic agents introduced to treat type 2 diabetes mellitus since 2006. Though the entire class increases the risk of BP by two‐fold, vildagliptin is implicated more than the others with an increased risk of developing BP by up to 10 fold . Gliptin induced BP generally does not affect the NC16A domain of BP180 resulting in a non‐ inflammatory presentation .…”

Section: Bullous Pemphigoidmentioning

confidence: 99%

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Review of autoimmune blistering diseases: the Pemphigoid diseases

Daniel

Murrell

2019

Acad Dermatol Venereol

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Autoimmune Blistering Diseases of the Pemphigoid type is characterised by sub‐epidermal blisters (SEB) with circulating autoantibodies against components of the basement membrane zone (BMZ). The main disorders to date include bullous pemphigoid (BP), pemphigoid gestationis, mucous membrane pemphigoid (MMP), epidermolysis bullosa acquisita (EBA), linear IgA disease (LABD), dermatitis herpetiformis (DH), lichen planus pemphigoides and bullous lupus. This is in contrast to pemphigus and related disorders, which demonstrate intraepidermal acantholysis and a positive Nikolsky sign. The classification and management is based on clinical, histological and direct and indirect immunofluorescence findings. There are, however, overlapping clinical and histological features between the conditions and clinical heterogeneity within each disease.

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Section: Bullous Pemphigoidmentioning

confidence: 99%

Section: Bullous Pemphigoidmentioning

confidence: 99%

Section: Bullous Pemphigoidmentioning

confidence: 99%

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Review of autoimmune blistering diseases: the Pemphigoid diseases

Daniel

Murrell

2019

Acad Dermatol Venereol

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Section: Introductionmentioning

confidence: 99%

“…Bullous pemphigoid (BP), the most common autoimmune subepidermal blistering disease, is characterized by itchy erythema and tense bullae on the whole body, especially in elderly individuals. 1 Autoantibodies in BP react with the hemidesmosomal antigens BP180 and BP230. 2 Complement deposition is detected at the basement membrane zone (BMZ) in 98% of BP cases, 3 which makes it a gold standard for diagnosing BP.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of IgG subclasses and complement deposition in BP230‐type bullous pemphigoid

Zheng

Ujiie

Iwata

et al. 2018

Acad Dermatol Venereol

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Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. BP180 is the primary autoantigen of BP, and in a portion of BP cases, BP230 is the only target of autoantibodies. Such BP is called BP230‐type BP. BP230‐type BP tends to show milder clinical phenotypes than conventional BP, but the reason is unclear. The pathogenic roles of autoantibodies and complement activation have been shown in conventional BP, but the distribution of IgG subclasses and the degree of complement deposition in BP230‐type BP remain unclear. Objective To compare the distribution of IgG subclasses and the degree of complement deposition in BP230‐type BP with those in conventional BP with autoantibodies to BP180 and BP230 (BP180‐BP230‐type BP). Methods The diagnosis of BP was confirmed by the histopathology of the lesions, the deposition of IgG and complement in the perilesional skin and the presence of circulating autoantibodies to BP180 and BP230. The disease severity was determined by bullous pemphigoid disease area index. The deposition of IgG subclasses and complement deposition were examined by direct immunofluorescence of the perilesional skin in 6 BP230‐type BP cases and 11 BP180‐BP230‐type BP cases. Results Sixty seven percent of BP230‐type BP cases show a mild clinical phenotype. All BP230‐type BP cases and 82% of BP180‐BP230‐type BP cases were found to demonstrate the clear deposition of IgG4 at the basement membrane zone of skin specimens. Notably, the deposition of IgG1 and IgG3 was faint or negative in all of the BP230‐type BP cases, whereas they were clearly detected in 91% and 64% of the BP180‐BP230‐type BP cases, respectively. The deposition of complement C3 tended to be weaker in BP230‐type BP than in BP180‐BP230‐type BP. Conclusion The mild clinical phenotype of BP230‐type BP may correlate with the weaker deposition of IgG1, IgG3 and complement in the skin lesions.

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Association Between Medication Use and Bullous Pemphigoid

2020

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IMPORTANCEThe association between the use of medications and the development of bullous pemphigoid (BP) is unclear.OBJECTIVE To assess the associations between previous exposure to certain medications and BP.DATA SOURCES For this systematic review and meta-analysis, PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched for relevant studies from inception to February 20, 2020.STUDY SELECTION Case-control or cohort studies and randomized clinical trials that examined the odds or risk of BP in patients with previous medication use were included. No geographic or language limitations were imposed. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline was followed. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of included observational studies; Cochrane Collaboration's tool was used for randomized clinical trials. Aggregate data were used to conduct a random-effects model meta-analysis if the included studies were sufficiently homogenous. Subgroup analyses were performed for use of various medications of the same category. MAIN OUTCOMES AND MEASURESOdds ratio (OR), hazard ratio, and risk ratio of bullous pemphigoid in association with medication use. RESULTSThis meta-analysis included 13 case-control studies, 1 cohort study, and 1 randomized clinical trial with a total of 285 884 participants. The meta-analysis of case-control studies showed a significant association of BP with previous use of aldosterone antagonists (pooled OR, 1.75; 95% CI, 1.28-2.40), dipeptidyl peptidase 4 inhibitors (pooled OR, 1.92; 95% CI, 1.55-2.38), anticholinergics (pooled OR, 3.12; 95% CI, 1.54-6.33), and dopaminergic medications (pooled OR, 2.03; 95% CI, 1.34-3.05). One cohort study found an increased risk of BP among patients receiving dipeptidyl peptidase 4 inhibitors (hazard ratio, 2.38; 95% CI, 1.16-4.88; P = .02). One trial found a higher occurrence of BP in patients with diabetes receiving linagliptin (0.2% in diabetes group vs 0% in the placebo group). CONCLUSIONS AND RELEVANCEThe findings of this systematic review and meta-analysis suggest that aldosterone antagonists, dipeptidyl peptidase 4 inhibitors, anticholinergics, and dopaminergic medications are associated with BP. These medications should be judiciously prescribed, particularly in high-risk patients who are elderly and have disabling neurologic disorders.

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The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

Cited by 184 publications

References 105 publications

Review of autoimmune blistering diseases: the Pemphigoid diseases

Review of autoimmune blistering diseases: the Pemphigoid diseases

Characteristics of IgG subclasses and complement deposition in BP230‐type bullous pemphigoid

Association Between Medication Use and Bullous Pemphigoid

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