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Chen Z, Wang L, Ma L, Yang F, Chen S, Yang J, Gao H, Tang C, Zhao Y, Zhang Z, Tang L, Xue H, Ying J, Xu Y, Zhang W, Shao L, Liu H, Luo X. Epidemiological Insights into Autoimmune Bullous Diseases in China: A Comprehensive Analysis. J Epidemiol Glob Health 2024:10.1007/s44197-024-00277-7. [PMID: 39037699 DOI: 10.1007/s44197-024-00277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE This study aims to conduct an extensive analysis of autoimmune bullous diseases, particularly pemphigus vulgaris and bullous pemphigoid, in Shanghai, China, from 2016 to 2023. It seeks to understand the demographic profiles, comorbidities, mortality rates, risk factors, and socioeconomic impacts associated with autoimmune bullous disease. METHODS A cross-sectional study design was employed, enrolling 1,072 patients. Diagnostic measures included clinical manifestations, histopathology, direct immunofluorescence, and serologic tests. The study also involved a detailed socioeconomic analysis and evaluation of occupational risks. RESULTS The findings highlight a significant occupational risk in industries requiring enhanced safety measures, with a notable prevalence of autoimmune bullous disease among workers in these sectors. A considerable portion of the patients were from low-income backgrounds with limited literacy, indicating the economic burden of autoimmune bullous disease. A key discovery of the study is the potential pathological link between autoimmune bullous disease and interstitial lung disease. CONCLUSION This research, one of the first comprehensive studies on autoimmune bullous disease in China, underscores the need for targeted healthcare strategies and further investigation into autoimmune bullous disease, particularly its relationship with interstitial lung disease.
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Affiliation(s)
- Zihua Chen
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Lanting Wang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Li Ma
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Fanping Yang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Shengan Chen
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Jin Yang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Haiqing Gao
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Chang Tang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Ying Zhao
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Zhen Zhang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Lin Tang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Haiyu Xue
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Jian Ying
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Yu Xu
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China.
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Karakioulaki M, Eyerich K, Patsatsi A. Advancements in Bullous Pemphigoid Treatment: A Comprehensive Pipeline Update. Am J Clin Dermatol 2024; 25:195-212. [PMID: 38157140 PMCID: PMC10866767 DOI: 10.1007/s40257-023-00832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
ABASTRACT Bullous pemphigoid (BP) is a common autoimmune bullous disease affecting mainly the elderly, with rising incidence due to increased life expectancy. This disease is characterized by tense bullous lesions on normal or erythematous skin, accompanied by pruritus. BP pathogenesis involves autoantibodies against hemidesmosomal proteins BP180 and BP230, leading to detachment at the dermo-epidermal junction as well as blister formation. BP is associated with coexisting comorbidities and drug exposure, and its management often requires high doses or chronic use of systemic glucocorticoids, posing risks of adverse effects. This review focuses on novel treatment options for BP, exploring therapies targeting different immune pathways. Rituximab, a CD20 monoclonal antibody, depletes B-lymphocytes and has shown efficacy in severe cases. Dupilumab, targeting interleukin (IL)-4 receptor α and thus blocking IL-4 and IL-13, downregulates type 2 helper (Th2) responses and has demonstrated promising results. Targeting eosinophil-related molecules using bertilimumab and AKST4290 has yielded positive results in clinical trials. Omalizumab, an immunoglobulin (Ig) E antibody, can reduce disease severity and allows corticosteroid tapering in a number of cases. Complement inhibitors such as nomacopan and avdoralimab are being investigated. IL-17 and IL-23 inhibitors such as secukinumab and tildrakizumab have shown potential in a limited number of case reports. Neonatal Fc receptor antagonists such as efgartigimod are under investigation. Additionally, topical therapies and Janus kinase inhibitors are being explored as potential treatments for BP. These novel therapies offer promising alternatives for managing BP, with potential to improve outcomes and reduce high cumulative doses of systemic corticosteroids and related toxicities. Further research, including controlled clinical trials, is needed to establish their efficacy, safety, and optimal dosing regimens for BP management.
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Affiliation(s)
- Meropi Karakioulaki
- Department of Dermatology and Venerology, Medical Center, University Hospital Freiburg, Freiburg, Germany
| | - Kilian Eyerich
- Department of Dermatology and Venerology, Medical Center, University Hospital Freiburg, Freiburg, Germany
| | - Aikaterini Patsatsi
- Second Department of Dermatology, School of Medicine, Papageorgiou Hospital, Aristotle University, Thessaloníki, Greece.
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He MJ, Wang YJ, Ran DL, Fu DS, He Q, Zhang HY, Mao Y, Zhao PY, Yu JB, Zhang JA. Relationship between bullous pemphigoid and malignancy: A Mendelian randomization study. J Dermatol 2024; 51:403-408. [PMID: 38212903 DOI: 10.1111/1346-8138.17100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
Bullous pemphigoid (BP) is the most common autoimmune blistering disease, which primarily affects the elderly. However, the relationship between BP and malignancy remains controversial in traditional observational studies. The aim of this study, which included only European populations, was to assess the potential causative link between BP and 13 types of malignant tumors in a two-sample Mendelian randomization (MR) study. BP was not associated with an increased risk of developing 13 types of malignant tumors. This study did not find a causal relationship between BP and malignant tumors. However, further research is warranted to examine the generalizability of this conclusion in non-European populations.
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Affiliation(s)
- Ming-Jie He
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu-Jia Wang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - De-Long Ran
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - De-Shuang Fu
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qing He
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Han-Yin Zhang
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu Mao
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peng-Yuan Zhao
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Bin Yu
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jiang-An Zhang
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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