Blisters in a Nursing Home: Bullous Pemphigoid More Often Than We Think?

Global Incidence and Prevalence of Bullous Pemphigoid: a Systematic Review and meta-analysis

BACKGROUND

Integrated information on the global prevalence and incidence of bullous pemphigoid (BP) is lacking.

OBJECTIVE

To estimate the incidence and prevalence of BP in a systematic review and meta-analysis.

METHODS

Observational studies were included by using databases of Medline, EMBASE and Cochrane Library. Subgroup analysis was by continent, age, sex and country income level. Random-effects model was used. Between-study heterogeneity was assessed using the I² statistic.

RESULTS

The global incidence was 0.0419 per 1000 person-years (95% CI: 0.0414-0.0424). The incidence was 0.047 per 1000 person-years (95% CI: 0.0462-0.0477), 0.0419 per 1000 person-years (95% CI: 0.0411-0.0426), 0.0072 per 1000 person-years (95% CI: 0.0067-0.0078), 0.003 per 1000 person-years (95% CI: 0.0023-0.0039) in North America, Europe, Asia and Africa, respectively; 0.0202 per 1000 person-years (95% CI: 0.0196; 0.0208) and 0.0181 per 1000 person-years (95% CI: 0.0175; 0.0188) females and males; 0.001 per 1000 person-years (95% CI: 0.001-0.001), 0.002 per 1000 person-years (95% CI:0.001-0.002), 0.004 per 1000 person-years (95% CI: 0.004-0.004); 0.007 per 1000 person-years (95% CI: 0.007-0.008), 0.011 per 1000 person-years (95% CI: 0.011-0.012), 0.017 per 1000 person-years (95% CI: 0.015-0.018) for age < 50, 50-59, 60-69, 70-79, 80-89 and ≥90 years. 0.0038 per 1000 person-years (95% CI:0.0036-0.004112) (I2 = 99%, p<.05) and 0.0456 per 1000 person-years (95% CI:0.0450-0.0462) (I2 = 100%, p<.05). The pooled clinic-based prevalence was 0.79 % (95% CI: 0.75%-0.84%), and 1.13% (95% CI: 1.06%-1.21%), 0.21% (95% CI: 0.17%-0.26%), 0.13% (95% CI:0.1%-0.15%) for Asia, Africa and Europe.

CONCLUSIONS

This study identified the global incidence and prevalence of BP in terms of spatial and population distributions and among various income level. A relatively higher incidence was in Europe, females, older people and high-income level country. The prevalence was higher in Asia. These findings should be interpreted with caution due to high heterogeneity of included studies.

Bullous pemphigoid and percutaneous endoscopic gastrostomy

BACKGROUND

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder. It is rare in the general population but the prevalence was reported to be relatively high among the elderly in nursing homes. The aim of the study was to analyze the clinical characteristics and risk factor for BP in elderly patients with a long hospital stay.

METHODS

This was a retrospective survey with 36 hospitalized patients, aged 64 to 101 years, staying more than 2 years from July 2005 to April 2009. We encountered 5 newly occurring BP cases during this survey period and the remaining 31 patients were non-BP cases. All of these subjects were disabled elderly patients because of cerebral stroke, etc. We assessed the clinical variables as follows: age, sex, underling disease of hospitalization, length of hospital stay, feeding method, medication, tracheal tube indwelling and frequency of death and compared these 2 groups.

RESULTS

All of the patients underwent enteral feeding by percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. In the univariate analysis, PEG and tube feeding (PEG and NG) were associated with BP (p<0.05). The multivariate logistic and Cox proportional hazard regression analysis were performed with age, sex (elderly female is well known feature of BP) and PEG or tube feeding, demonstrating only PEG was significantly and independently associated with BP (p<0.05).

CONCLUSION

We found that PEG was significant risk factor for BP. Since the sample size was small in this survey, further study is required. Greater awareness of BP is needed for physicians managing institutionalized elderly patients with PEG.