Bullous pemphigoid and radiotherapy: case report and literature review update

Abstract

Bullous pemphigoid (BP) is a common autoimmune bullous disease generally occurring in elderly patients. Itchy and tense blisters on normal skin or erythematous and edematous lesions on the trunk and extremities usually characterize BP. Trigger factors are still unclear while several case reports suggest a potential role of radiotherapy (RT) as BP trigger for disease onset or recrudescence. A review was performed to provide an update of literature. A case report of a patient affected by BP undergoing two radiotherapy courses for a primary breast cancer was also reported. A comprehensive review of the published literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review included studies describing BP and its relationships with RT treatments. A total of 13 articles were reviewed. Studies characteristics analysis resulted in eleven case reports, one case series and one large-scale case– control study. Literature update confirms the existence of a reasonable connection between RT and BP. Case report showed that a multidisciplinary management seems to assure the feasibility of RT in patients affected by BP, not depriving them of standard therapeutic opportunities.

Radiation-Induced Localized Bullous Pemphigoid

“…1–5 In a minority of affected patients, BP develops during treatment, potentially mimicking other more common acute radiation sequalae/effects, compounding diagnosis and, if not readily recognized, delaying appropriate patient care. 1–5 Herein, we report an unusual case of localized, pauci-inflammatory BP that started during radiotherapy for breast cancer.…”

“…1–5 A relatively low dose of 20 Gy can induce skin lesions in some patients. 1–5 Up to two-fifths (41%) of patients progress to generalized disease. 1–5 Skin lesions typically develop months-to-years after treatment (range, 2 weeks to 16 years; mean, 15 months; median, 5 months).…”

“…1–5 Of note, radiotherapy has been shown to cause an increase in basement membrane antibody binding, likely secondary to endothelial cell injury and increased vascular permeability. 1–5 Concurrent medications (ie, chemotherapy, hormonal therapy) and other comorbidities (ie, chronic kidney disease) may also modulate the onset of radiotherapy-associated BP in some patients. 1–5…”

“…Bullous pemphigoid (BP) is a rarely described side-effect of external beam radiation therapy. 1–5 In reported cases, skin lesions typically arise after cessation of treatment and are localized to irradiation sites, on occasion spreading to nonirradiated skin or becoming more widespread. 1–5 In a minority of affected patients, BP develops during treatment, potentially mimicking other more common acute radiation sequalae/effects, compounding diagnosis and, if not readily recognized, delaying appropriate patient care.…”

“…1–5 In reported cases, skin lesions typically arise after cessation of treatment and are localized to irradiation sites, on occasion spreading to nonirradiated skin or becoming more widespread. 1–5 In a minority of affected patients, BP develops during treatment, potentially mimicking other more common acute radiation sequalae/effects, compounding diagnosis and, if not readily recognized, delaying appropriate patient care. 1–5 Herein, we report an unusual case of localized, pauci-inflammatory BP that started during radiotherapy for breast cancer.…”