Risk Factors for Bullous Pemphigoid in the Elderly: A Prospective Case–Control Study

Abstract

A rise in the incidence of bullous pemphigoid (BP) was documented recently in Europe, and the main risk factors for BP remain unknown. We conducted a multicenter case-control study to evaluate risk factors for BP. We identified 201 incident BP cases and 345 controls individually matched for age, gender, center, and place of residence (home, nursing home, or extended-care facility). We used univariate and multivariate logistic regression analyses to compare drugs used for over 3 months, comorbidities, and physical and cognitive impairments between cases and controls. Mean age of BP patients was 84.2 (±8.7) years. Factors independently associated with BP by multivariate analysis were major cognitive impairment (odds ratio (OR), 2.19; 95% confidence interval (95% CI), 1.24-3.87), bedridden condition (OR, 2.19; 95% CI, 1.23-3.89), Parkinson's disease (OR, 2.16; 95% CI, 1.09-4.27), unipolar or bipolar disorder (OR, 5.25; 95% CI, 1.21-22.86), and chronic use of spironolactone (OR, 2.30; 95% CI, 1.20-4.46) or phenothiazines with aliphatic side chains (OR, 3.70; 95% CI, 1.21-11.34). Chronic analgesic use was associated with a lower risk of BP (OR, 0.49; 95% CI, 0.30-0.81). Thus, risk factors for BP include neurological disorders, particularly dementia and Parkinson's disease, psychiatric disorders (unipolar and bipolar disorders), bedridden condition, and chronic use of several drugs.

Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

“…Th e reported incidence varies greatly among diff erent countries: from 0.25/100.000 inhabitants per year in Romania (6), through 2.2/100 000 inhabitants in France or 2.4/100.000 persons per year in the United States (8), to 4.3/100 000 persons per year in the United Kingdom (9). Th e incidence appears to be increasing in the last two decades (8,9), which may be attributed to greater proportion of older persons in the population (9), or to increasing incidence of neurological diseases, and use of certain medications which are implicated as risk factors for development of BP (10).…”

Possible triggering factors and comorbidities in newlydiagnosed autoimmune bullous diseases

“…It has been considered that the cross-reaction between the common sequences of different isoforms of the 230-kDa BP antigen (BPAG1) in the skin and the neurological system plays a role in the association of BP and neurological diseases (18,19). Gambichler et al.…”

“…In the first reports, when only systemic drugs were investigated, physical factors (such as local trauma, ultraviolet rays, and radiotherapy), infections, and vaccinations also began to be reported (9). The most identified drugs were diuretics, angiotensin-converting enzyme inhibitors, acetylsalicylic acid, and benzodiazepines (7,9,18,19). Although it was at a low percentage when compared to the study conducted by Daye et al, in our study, a relationship between the use of drugs and disease onset was determined in 24% of BP patients, and triggering drug use was determined in 44% of BP patients (7).…”

A Potential Link between Amyotrophic Lateral Sclerosis and Bullous Pemphigoid: Six New Cases and a Systematic Review of the Literature

“…Treatment for BP was successful, as oral prednisone and/or local corticosteroids were effective in all cases. With regard to neurological disorders in patients with BP, a prospective case-control study from France assessed the independent risk factors for BP, which included neurological disorders, particularly dementia and Parkinson's disease, psychiatric disorders (unipolar and bipolar disorders), bedridden condition, and chronic use of neuroleptics or spironolactone (6). Neurological disorders such as dementia occur frequently in the elderly, and unexpected cases of BP occurring in adult patients with various neurological disorders have been consistently reported (10).…”

“…Exposure to the neuronal antigen could lead to an immune reaction against the epithelial isoform. BP has been reported in adult patients with various neurological disorders, suggesting a potential relationship with neurodegenerative diseases (6).…”