Association between bullous pemphigoid and ischemic heart diseases: A systematic review and meta-analysis

Epidemiology and comorbidities in bullous pemphigoid in the period from January of 2019 to the January of 2021

Introduction: Bullous pemphigoid is an autoimmune bullous dermatosis that most commonly occurs in elderly patients. Due to its pathogenesis and treatment of the disease, it can also affect the development of comorbidities. Aim: Determination of comorbidities and their frequency in patients with bullous pemphigoid, as well as their distribution by sex and the estimation of the duration of dermatosis from the onset of symptoms to data collection. Material and methods: In the period from January 2019 to January 2021, a number of 80 patients was analyzed. Basic patient data (age, sex, time of illness) and data on accompanying comorbidities were obtained. Data were categorized based on the ICD-10 classification into groups of diseases, as well as individual diseases that occurred frequently in the population. Results: Of the total number of respondents, 41.3% were male and 58.8% female. The average age of the respondents was 75.8 years, 76.45 years for men and 75.36 years for women. The period from the onset of symptoms to data collection was 3 months, while the average age of the disease in all subjects was 74.4 years. The most common comorbidities were hypertension 73.75%, psychiatric diseases 25%, type 2 diabetes mellitus 25%, other skin diseases 21.25%, urinary tract disorders 18.75%, ischemic heart disease 12.5%, type 1 diabetes mellitus 10%, kidney disease 8.75%, neurological disease 6.25%. Comorbidities were statistically more common in female patients: hypertension, ischemic heart disease, skin diseases and type 2 diabetes mellitus. Conclusion: In our study, bullous pemphigoid is confirmed the disease is of the elderly, predominantly female. Female patients suffer from some comorbidities more often. The period from the onset of symptoms to the collection of data is about 3 months. It is also showed that there are a number of comorbidities in the studied pemphigoid population, however, a large number of studies are needed to determine their association.

A multicentre prospective analysis of the incidence of pemphigoid diseases in Turkey

BACKGROUND

The differentiation between the pemphigoid diseases is essential for treatment and prognosis. In Turkey, data on the incidence of these diseases are insufficient. Our aim in this study is to determine the incidence, demographics and clinical characteristics associated with diseases of the pemphigoid group.

METHODS

We prospectively analysed 295 patients with pemphigoid who visited dermatology clinics of tertiary referral hospitals in 12 different regions of Turkey within a year. The diagnosis was based on clinical, histopathological, direct immunofluorescence (DIF) and serological (multivariant enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence and mosaic-based BIOCHIP) examinations. Clinical and demographic findings, aetiological factors and concomitant diseases observed in the patients were recorded.

RESULTS

A total of 295 (female/male ratio: 1.7/1) patients with pemphigoid were diagnosed in 1-year period. The overall incidence rate of pemphigoid diseases was found to be 3.55 cases per million-years. The ratio of pemphigoid group diseases to pemphigus group diseases was 1.6. The most common pemphigoid type was bullous pemphigoid (BP, 93.2%). The others were epidermolysis bullosa acquisita (3.1%), pemphigoid gestationis (2.4%), linear IgA disease (1%) and mucous membrane pemphigoid (0.3%). The most common (26.8%) possible trigger of the bullous pemphigoid was gliptin derivative drugs. The most common concomitant diseases with pemphigoid were cardiovascular (27.8%) and neurological diseases (23.7%).

CONCLUSIONS

This study showed that the increased frequency of bullous pemphigoid reversed the pemphigoid/pemphigus ratio in Turkey. Further studies are warranted regarding the reasons for this increase.

Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease

Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.