title: Bullous pemphigoid in infants: characteristics, diagnosis and treatment.
abstract: BACKGROUND
  Bullous pemphigoid (BP) in infants is a rare but increasingly reported autoimmune blistering skin disease. Autoantibody reactivity is usually poorly characterized. Current guidelines do not address specific aspects of the infantile form of BP. The objectives of this study are to define clinical and diagnostic characteristics of infantile BP and develop a treatment algorithm.
  
  
  METHODS
  Detailed characterization of a current case series of five infants with BP from our departments. Comprehensive analysis of all reported cases (1-12 months) with respect to clinical and laboratory characteristics, treatment and outcome.
  
  
  RESULTS
  In total 81 cases were identified (including our own). The mean age was 4.5 months. Moderately severe and severe disease was seen in 84% of cases. Involvement of hands and feet was present in all cases. Immunofluorescence microscopy was comparable with BP in adults. Where analyzed, the NC16A domain of bullous pemphigoid 180 kDa antigen/collagen XVII (BP180) was identified as the major target antigen. BP180 NC16A ELISA values in our cohort were significantly higher than in a control cohort of 28 newly diagnosed adult patients. 50% of patients were treated with systemic corticosteroids, 20% with a combination of systemic corticosteroids and dapsone or sulfapyridine and 10% with topical corticosteroids alone. 14% of patients needed a combination of multiple immunosuppressants. All but one patient reached remission. Relapses were rare.
  
  
  CONCLUSIONS
  Presentation of infantile BP is often severe with blistering of hands and feet present in all cases. Pathogenesis and diagnostic criteria are comparable to adult BP, yet BP180 NC16A ELISA levels seem to be significantly higher in infants. The overall disease outcome is favorable. Based on the results of this study we propose a treatment algorithm for infantile BP.
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. agnes.schwieger@uniklinik-freiburg.de.|Department of Dermatology, Medical Center - University of Freiburg, Hauptstrasse 7, Freiburg, 79104, Germany. agnes.schwieger@uniklinik-freiburg.de.
authors.forename: Agnes
authors.initials: A
authors.lastname: Schwieger-Briel
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. cornelia.moellmann@uniklinik-freiburg.de.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Moellmann
authors.affiliation: Children's Hospital "Klinik am Eichert", Goeppingen, Germany. Birgit.Mattulat@af-k.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Mattulat
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. franziska.schauer@uniklinik-freiburg.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Schauer
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. dimitra.kiritsi@uniklinik-freiburg.de.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Kiritsi
authors.affiliation: Department of Dermatology, University of Luebeck, Luebeck, Germany. Enno.Schmidt@uk-sh.de.
authors.forename: Enno
authors.initials: E
authors.lastname: Schmidt
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. cassian.sitaru@uniklinik-freiburg.de.
authors.forename: Cassian
authors.initials: C
authors.lastname: Sitaru
authors.affiliation: Department of Dermatology, University of Luebeck, Luebeck, Germany. h.ott@KKH-Wilhelmstift.de.|Catholic Children's Hospital Wilhelmstift, Hamburg, Germany. h.ott@KKH-Wilhelmstift.de.
authors.forename: Hagen
authors.initials: H
authors.lastname: Ott
authors.affiliation: Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. johannes.steffen.kern@uniklinik-freiburg.de.
authors.forename: Johannes S
authors.initials: JS
authors.lastname: Kern
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones