Bullous Pemphigoid Linked to Preexisting Stroke, Malignancies

Bullous pemphigoid
Bullous pemphigoid
A novel study asks: Does a correlation exist between preexisting comorbidities and serum titers of anti-BP180 and 230 antibodies in patients with bullous pemphigoid (BP)?

Neurologic disorders, particularly stroke, as well as malignancies are significantly associated with the occurrence of bullous pemphigoid (BP), according to study findings published in Dermatologic Therapy.

Investigators retrospectively reviewed data of patients who were consecutively diagnosed with BP at the Istanbul Faculty of Medicine in Turkey from 1987 to 2017. The researchers sought to determine whether a correlation exists between pre-existing comorbidities and serum titers of anti-BP180 and 230 antibodies in patients with BP.

The analysis included 145 patients with BP and 310 age- and sex-matched control participants. Patients with BP included 66 men (45.5%), compared with 142 men (45.8%) in the control group. Patients’ mean age at the time of BP diagnosis was 66.40 ± 15.37 years (median, 70 years; range, 23-102 years), vs a mean age of 65.47 ± 13.29 years (median, 69 years; range, 25-96 years) for control participants. The BP group had a mean follow-up of 29.11 ± 43.06 months.

A total of 19.3% patients with BP had at least 1 preexisting neurologic disorder at the onset of BP lesions, and 11% of control participants) had at least 1 neurologic disorder. Stroke was the most frequent neurologic disorder in the BP group (12.4%) and in the control group (5.8%).

Logistic regression analysis (odds ratio [OR] = 1.943; 95% CI, 1.127-3.350; P = .017) showed that neurologic disorders occurred significantly more frequently in patients with BP compared with the control group participants. Stroke was the only neurologic disorder that was more common in BP patients than in control participants (OR = 2.299; 95% CI, 1.158-4.564; P = .017).

A total of 13.8% patients with BP were diagnosed with at least 1 type of malignancy before their BP diagnosis or during the initial tests that were conducted immediately after their BP diagnosis. Logistic regression analysis confirmed a significant association between BP and malignancies (OR = 2.597; 95% CI, 1.328-5.076; P = .005).

The mean serum anti-BP180 and BP230 IgG antibody titers of patients with stroke (anti-BP180 = 11.2; anti-BP230 = 3.5) were higher than those of patients without stroke (anti-BP180 = 3.8; anti-BP230 = 1.8), which was statistically significant (P < .001; P = .036).

The investigators noted that their study is limited by its retrospective design and the relatively low number of patients with BP who were tested for serum titers of anti-BP180 and 230 antibodies before their initial treatment.

“As far as we know, this is the first study to report a statistically significant association between the high serum titers of anti-BP IgG autoantibodies and BP-associated neurologic disorders,” the researchers commented.


Sayar S, Sun GP, Küçükoğlu R, et al. Comorbidities of bullous pemphigoid: a single-center retrospective case control study from Turkey. Dermatol Ther. Published online June 16, 2021. doi:10.1111/dth.15031