Tissue eosinophil levels as a marker of disease severity in bullous pemphigoid

Abstract

Background: Eosinophils play an important role in bullous pemphigoid (BP) pathogenesis. Although tissue infiltration with eosinophils has been known for a long time, there is a lack of knowledge about the relationship between tissue eosinophil levels and disease severity and clinical characteristics of the patients.Methods: Fifty-nine patients diagnosed with BP between January 2008 and December 2018 were reviewed. Haematoxylin-Eosin (H&E)-stained preparations were re-evaluated in terms of tissue eosinophil levels. For disease severity, Bullous Pemphigoid Disease Area Index (BPDAI) was used. The relationship between tissue eosinophil levels and disease severity and clinical features were evaluated.Results: Erosion/blister and urticaria/erythema BPDAI scores were higher in the group with high tissue eosinophil level than the group with low tissue eosinophil level. Tissue and peripheral blood eosinophil count were correlated with total urticaria/erythema BPDAI scores. There was no correlation between blood and tissue eosinophil count. The mortality rate was 64.7% vs 44.0% in the high vs low tissue eosinophil groups. Tissue eosinophil levels were high in patients with BP accompanying neurological disease.Conclusions: Tissue eosinophil count and peripheral blood eosinophil count were correlated with disease severity in BP. Tissue eosinophil levels were also high in patients with BP accompanying neurological disease.

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

“…Neurological diseases were significantly more common in patients with BP with high levels of eosinophils in the tissue. This finding is consistent with the results of a recent study by Karaali et al ( 21 ), which demonstrated a correlation between patients with BP with neurological disease and high tissue eosinophil counts. The study suggested that eosinophils may have a common role in the pathogenesis of BP and neurological diseases; however, further studies are needed to prove this theory ( 21 ).…”

“…This finding is consistent with the results of a recent study by Karaali et al ( 21 ), which demonstrated a correlation between patients with BP with neurological disease and high tissue eosinophil counts. The study suggested that eosinophils may have a common role in the pathogenesis of BP and neurological diseases; however, further studies are needed to prove this theory ( 21 ). No differences were found in the prevalence of other comorbidities, including cardiac disease, diabetes, malignancy, and autoimmunity.…”

“…This was in contrast to the results of a study by Farnaghi et al ( 24 ), which demonstrated a correlation between dermal eosinophilia and BPDAI. Karaali et al ( 21 ) also showed that BPDAI scores were higher for patients with high tissue eosinophil levels. This could be explained by the differences in the ethnic and geographical characteristics of the participants, and by the different sample sizes in the current study.…”

“…No differences were found in the prevalence of other comorbidities, including cardiac disease, diabetes, malignancy, and autoimmunity. Karaali et al ( 21 ) also showed that there was no association between malignancy and tissue eosinophil levels; however, they did not assess other comorbidities. There are no other studies in the literature that have evaluated the relationship between comorbidities associated with BP and skin eosinophil counts.…”

Bullous pemphigoid—What do we know about the most recent therapies?

“…One study found a positive correlation between tissue eosinophil level and the quantity of inflammatory lesions ( 26 ). However, with regards to the relationship between blood eosinophil count and severity of BP measured by the Bullous Pemphigoid Disease Activity Index scores, confounding data exists ( 10 , 27 – 29 ).…”