Bullous pemphigoid and radiotherapy: case report and literature review update

Abstract

INTROUDCTION 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 in order 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. MATERIALS AND METHODS A comprehensive review of the published literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The review included studies describing BP and its relationships with RT treatments. RESULTS 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. CONCLUSIONS 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

“…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.…”

“…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.…”

“…Cutaneous adverse effects during and after external beam radiation therapy for breast cancer are common, with “radiation dermatitis” occurring in 74%–100% of patients. 1–5 Other known cutaneous side-effects include radiation-induced morphea, radiation-induced fibrosis, radiation recall dermatitis, secondary malignancies, erosions, and ulcerations. 1 Blistering skin diseases, including immunobullous disorders, are rarely triggered by radiotherapy.…”

“…1–5 Other known cutaneous side-effects include radiation-induced morphea, radiation-induced fibrosis, radiation recall dermatitis, secondary malignancies, erosions, and ulcerations. 1 Blistering skin diseases, including immunobullous disorders, are rarely triggered by radiotherapy. 1–5…”