Increased frequency of multiple sclerosis among patients with bullous pemphigoid: a population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid

Abstract

We discovered a significantly increased frequency of MS among patients with BP. At the time of diagnosis, patients with BP had an excessive number of comorbidities and an increased mortality rate over the following years.

Neurological disorders are associated with bullous pemphigoid

“…11,12 There is growing evidence to suggest an association between BP and a range of neurological disorders including dementia, cerebral stroke, Parkinson's disease, cerebrovascular disease, multiple sclerosis, epilepsy and polyneuropathies. [13][14][15][16][17][18][19][20][21][22] While the immunological mechanisms have not been fully elucidated, the association between BP and neurological disorders may be due to immune responses arising from cross-reactivities of skin autoantibodies with BP antigens or their isoforms that are known to be expressed in brain and neuronal tissue. 8,10,14,23 In our study, we aimed to analyse the clinical characteristics of patients with BP and to assess the relationship between BP and neurological disorders.…”

Multiple sclerosis is the neurological disorder most highly associated with bullous pemphigoid

“…In this issue of the BJD , Kibsgaard et al . present a register‐based matched cohort study on all Danish patients with a hospital‐based diagnosis of BP over a 38‐year period.…”

A possible association between BP230-type bullous pemphigoid and dementia: a report of two cases in elderly patients

“…2 BP antigens and their isoforms can be identified in skin and in neuronal tissues, suggesting that exposure of the neuronal antigen may lead to an immune reaction against the epithelial isoform. 3 Here, we describe two cases of BP in elderly patients with dementia in which the autoantibodies reacted to BP230 but not to BP180 (BP230type BP).…”

“…BP230 (BPAG1e) is an epithelial isoform of dystonin, and its neuronal isoform BPAG1a is expressed in the nervous system . All isoforms of dystonin share the same plakin domain, suggesting that immune reactions against BPAG1a in neuronal tissues are linked to the generation of autoantibodies to BP230 . Furthermore, ageing is considered to be a cause of the disruption of the blood–brain barrier (BBB) .…”

“…7 All isoforms of dystonin share the same plakin domain, 7 suggesting that immune reactions against BPAG1a in neuronal tissues are linked to the generation of autoantibodies to BP230. 3 Furthermore, ageing is considered to be a cause of the disruption of the blood-brain barrier (BBB). 8 These facts lead us to speculate that neuronal antigen exposure resulting from neurodegeneration in patients with dementia occurs and that those antigens are recognized by the immune system because of the age-related compromise of the BBB in elderly patients.…”