Bullous Dermatoses and Depression

Abstract

ullous diseases affecting the skin and mucosa can have a substantial role in patients' quality of life and mental health. The most common bullous dermatoses include bullous pemphigoid and pemphigus vulgaris, which have an incidence of 4.3 and 0.1 to 0.7 per 100 000 persons worldwide, respectively. 1,2 Bullous pemphigoid and pemphigus vulgaris are both autoimmune bullous dermatoses, with antibodies to hemidesmosomes and desmoglein, respectively. 3 Epidermolysis bullosa (EB) is an inherited disorder caused by either autosomal dominant or recessive variants in genes that code structural proteins. Overall, bullous dermatoses are associated with substantial morbidity and mortality. Specifically, bullous dermatoses are associated with an increased risk of cardiovascular disease, 4 neurologic disease, 5 other autoimmune diseases, 6 and a negative outcome on quality of life. 7 Approximately 1 in 3 patients with skin disease experience depression,anddepressionhasbeenassociatedwithlowermedicationadherence and worsening disease severity among dermatology patients. 8,9 Patients with bullous skin diseases may be especially susceptible to developingmentalhealthcomorbiditiesowingtothechronicphysicaland emotional outcomes of these diseases. However, there is a critical lack of evidence synthesis on the prevalence of depression among patients with bullous skin diseases. This systematic review aims to synthesize andinterpretthecurrentevidenceondepressionanddepressivesymptoms among patients diagnosed with bullous dermatoses. Methods Search Strategy and Study SelectionIn conducting this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. 10 We conducted searches of the PubMed, Embase, Cochrane, and PsycInfo databases in February 2021. This systematic review was prospectively registered with PROSPERO (CRD42021230750). Database searches included articles published between 1945 and February 2021 using MeSH search terms ("Skin Diseases, Vesiculobullous" [MeSH] AND "Depression" [MeSH]), as appropriate. The initial database searches yielded a total of 271 results (Figure).Two team members, S.P.P. and Y.G., reviewed the titles and abstracts of the articles and applied inclusion and exclusion criteria to determine eligibility for this review. We also reviewed reference lists of relevant articles. For this review, inclusion criteria included patients of all ages diagnosed with bullous skin disease who were screened for depression or diagnosed with depression. Articles without primary data, case reports, and those not limited to human study were excluded. All discrepancies were mediated by A.W.A. After reviewing article titles and abstracts, S.P.P. and Y.G. determined that 36 were eligible for full-text review. IMPORTANCE There is a lack of evidence synthesis on the association between bullous skin disease and depression.OBJECTIVE To synthesize and interpret the current evidence on the association between bullous skin disease and depression.EVIDENCE REVIEW This review was co...

The Prevalence of Clinically Undiagnosed Depression in Patients With Autoimmune Bullous Diseases Seen at Inkosi Albert Luthuli Central Hospital, Durban, South Africa

“…Apart from the potential inflammatory etiopathogenesis, AIBDs reduce an individual's self-esteem and quality of life leading to psychosocial effects inclusive of depression [16]. Previous studies have indicated that the prevalence of depressive symptoms ranges from 40% to 80%, while that of major depression ranges from 11.4% to 28% [12]. This is significantly lower than the prevalence observed in our clinic.…”

“…Moreover, there is no local study characterizing the mental health of patients with autoimmune bullous diseases (AIBDs). Given the lack of local data on this subject [12], we conducted a cross-sectional study to determine the prevalence and severity of clinically undiagnosed depression in patients with AIBDs.…”

Prevalence, Spectrum and Clinical Implications of Malignancies in Patients with Bullous Pemphigoid

“…10.7% vs 4.3%, respectively, p = 0.0005). Of the 13 cases of a Alopecia areata, vitiligo, urticaria.…”

“…BP has been linked with a variety of comorbidities, including neurological illnesses (multiple sclerosis, dementia, Parkinson’s disease, epilepsy, and stroke) ( 8 ); an elevated risk of thromboembolic events ( 9 ); psychiatric disorders ( 10 ); dermatoses (psoriasis and lichen planus) ( 11 , 12 ); and various medications ( 13 ). The link between BP and malignancy has also been studied with conflicting results.…”

Burden of pemphigus vulgaris with a particular focus on women: A review

“… 50 A recent systematic review has shown that the prevalence of depressive symptoms and clinical depression among patients with autoimmune bullous disorders (AIBDs) ranged from 40 to 80% and 11.4 to 28%, respectively. 51 Wohl et al 52 evaluated records of 764 individuals in Israel (255 pemphigus patients and 509 controls) and found that depression was higher in pemphigus patients with an odds ratio of 1.19 (95% confidence interval (CI): 1.12-1.27). Similarly, Hsu et al 53 analyzed 4600 medical records in Taiwan (926 pemphigus patients and 3674 controls) and reported that pemphigus patients were more likely to suffer from depression with an adjusted hazard ratio of 1.99 (95% CI: 1.37-2.86).…”