Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French Bullous Study Group.
OBJECTIVE
To check the potential usefulness of clinical criteria for the diagnosis of bullous pemphigoid when state-of-the-art techniques such as Western immunoblotting, immunoprecipitation, and indirect immunofluorescence on salt-split skin or direct immunoelectron microscopy are not available.


METHODS
Comparison of the clinical criteria between 2 groups (with and without bullous pemphigoid) as defined by immunoelectron microscopy used as standard criterion, in a prospective study. Multivariate logistic regression analysis was carried out by including all items that were statistically significant (at P < .05 level) in univariate analysis.


METHODS
Five dermatology departments in teaching hospitals.


METHODS
The 231 patients studied had subepidermal autoimmune bullous diseases with linear IgG or C3 deposits in the basement membrane zone (157 with bullous pemphigoid, 33 with cicatricial pemphigoid, 30 with epidermolysis bullous acquisita, 5 with lupus erythematosus, and 6 others). A second set of patients was used to calculate predictive values.


RESULTS
The multivariate logistic stepwise analysis resulted in a final set of predictors that included only 4 items: absence of atrophic scars, absence of head and neck involvement, absence of mucosal involvement, and age greater than 70 years. No additional variables met the .05 significance level to enter into the model. If 3 of these 4 characteristics were present, a diagnosis of bullous pemphigoid could be made with a sensitivity of 90% and a specificity of 83%; these predictive values were calculated on a sample of 70 new cases.


CONCLUSIONS
With and estimated incidence of bullous pemphigoid among subepidermal autoimmune bullous diseases of 80%, the presence of 3 of the 4 significant criteria allows the diagnosis of bullous pemphigoid, with a positive predictive value of 95%. Our set of clinical criteria thus allows the diagnosis of bullous pemphigoid with good validity for both clinical practice and therapeutic trials.
Department of Dermatology, Hôpital Trousseau, Tours, France.
L
L
Vaillant
P
P
Bernard
P
P
Joly
C
C
Prost
B
B
Labeille
C
C
Bedane
B
B
Arbeille
E
E
Thomine
P
P
Bertrand
C
C
Lok
J C
JC
Roujeau
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010391:Pemphigoid, Bullous / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity