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Updated: Apr 20, 2026
Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Comparative Clinical and Histological Analysis of Bullous Pemphigoid: Immunotherapy-Associated versus Spontaneous
Thilo Gwerder1, Reinhard Dummer1,2, Thomas Kuendig1
1Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland.
Introduction:
Immune checkpoint blockade (ICB) therapy can be associated with the development of bullous pemphigoid (BP). To characterize clinical, histological, and serological characteristics, we compared immune-related bullous pemphigoid (irBP) and spontaneous bullous pemphigoid (sBP) considering clinical, serological, and histopathological character.
Methods:
149 BP patients treated at the University Hospital Zurich between 2015 and 2024 were identified retrospectively. Demographic and serological data were obtained from electronic records. Hematoxylin-eosin-stained biopsies were semi-quantitatively evaluated for immune cell infiltrates, split formation, and infiltration patterns.
Results:
From the total of 149 cases, 17 were irBP and 132 were sBP. Patients affected by irBP were predominantly males (94%), females were slightly overrepresented in sBP (51.5%) and BP was less often suspected at presentation (59% vs. 85% in sBP). Anti-BP230 antibodies were more frequently elevated in sBP (64.4% vs. 23.5% in irBP). Histologically, irBP cases showed denser eosinophilic and lymphocytic infiltrates, as assessed by semi-quantitative scoring.
Conclusion:
irBP differs from sBP by showing denser immune-infiltrates, lower rates of elevated anti-BP230 antibodies and predominantly affect males. These observations suggest that irBP represents a distinct subtype and highlight the need for diagnostic awareness in the setting of ICB therapy.
