Bullous pemphigoid in Liguria: a 2-year survey.
BACKGROUND
The epidemiology of bullous pemphigoid (BP) is not clear because of the heterogeneity of the disease, and its possible association with internal malignancies has been under debate for many years. We report the findings of a 2-year study on incident BP cases in the Liguria region of Italy.


METHODS
Thirty-two patients with BP were collected over the 2-year period. Diagnosis was made based on clinical findings and confirmed by histology, direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) with salt-split skin and monkey oesophagus, and immunoblotting (IB). All patients were thoroughly investigated for possible malignancies and all were followed up for 6 months to monitor the response to treatment.


RESULTS
DIF showed linear deposits at the dermoepidermal junction in all but one patient. IIF gave positive findings for 15 sera tested with monkey oesophagus and 20 tested with salt-split skin. IB gave positive findings in 19 cases. There was a malignancy in six cases, but no clinical or immunological features that could be considered to predict this occurrence.


CONCLUSIONS
The findings of this study are in accordance with most of the data found in the literature, including the fact that IgG serum levels did not predict the course of the disease. Contrary to previous indications, IgE levels were not indicative of disease course either. Mucosal lesions, erythema multiform-like lesions, negative IIF findings and antibodies to AgPB2 were not a prediction for the development of malignancy.
Cozzani
E
E
Clinica Dermatologica, Università di Genova, Italy.
Parodi
A
A
Rebora
A
A
Delmonte
S
S
Barile
M
M
Nigro
A
A
Priano
L
L
Troiano
G
G
Patri
P L
PL
D000368:Aged; D000369:Aged, 80 and over; D001324:Autoantigens / Q000032:analysis; D002352:Carrier Proteins; D003094:Collagen / Q000032:analysis; D003176:Complement C3 / Q000032:analysis; D003598:Cytoskeletal Proteins; D000071821:Dystonin; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D010391:Pemphigoid, Bullous / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D012867:Skin / Q000276:immunology; D000097805:Collagen Type XVII
D001324:Autoantigens; D002352:Carrier Proteins; D003094:Collagen; D003176:Complement C3; D003598:Cytoskeletal Proteins; D000071821:Dystonin; D007073:Immunoglobulin E; D007074:Immunoglobulin G; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C486268:DST protein, human