Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients.
BACKGROUND
Although rare, bullous pemphigoid (BP) is the most common autoimmune blistering disease. Recent studies have shown that patients with bullous pemphigoid are more likely to have neurological and psychiatric diseases, particularly prior to the diagnosis of bullous pemphigoid.


OBJECTIVE
The aims were: (i) to evaluate the demographic and clinical features of bullous pemphigoid from a database of patients at a Portuguese university hospital and (ii) to compare the prevalence of comorbid conditions before the diagnosis of bullous pemphigoid with a control group.


METHODS
Seventy-seven patients with bullous pemphigoid were enrolled in the study. They were compared with 176 age- and gender-matched controls, which also had the same inpatient to outpatient ratio, but no history of bullous or cutaneous malignant disease. Univariate and multivariate analyses were used to calculate odds ratios for specific comorbid diseases.


RESULTS
At least one neurologic diagnosis was present in 55.8% of BP patients compared with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in 35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25 (2.71-10.16); and Parkinson's disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using multivariate analysis, all diseases except Parkinson's retained their association with BP. Patients under systemic treatment were eight times more likely to have complications than those treated with topical steroids (p< 0.017).


CONCLUSIONS
The results of this study substantiate the association between BP and neurological diseases. In addition, they highlight the potential complications associated with the treatment of BP.
Coimbra University Hospital, Portugal.
Vera Barreto
VB
Teixeira
Coimbra University Hospital, Portugal.
Rita
R
Cabral
Coimbra University Hospital, Portugal.
Maria Manuel
MM
Brites
Coimbra University Hospital, Portugal.
Ricardo
R
Vieira
Coimbra University Hospital, Portugal.
Américo
A
Figueiredo
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution