Mucosal Involvement in Bullous Pemphigoid: Severity Indicator and Associated Clinical Features from a Retrospective...

Area of Science:

• Dermatology
• Immunodermatology
• Autoimmune Blistering Diseases

Background:

• Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease.
• Mucosal involvement in BP, though uncommon, is linked to a more severe clinical presentation.

Purpose of the Study:

• To evaluate the prevalence of mucosal involvement in bullous pemphigoid.
• To identify clinical features associated with mucosal involvement in BP patients.

Main Methods:

• A retrospective cohort study of 265 BP patients diagnosed between January 2013 and May 2022.
• Comparison of clinical, laboratory, and immunological characteristics between patients with and without mucosal involvement.
• Logistic regression and ROC analysis to identify factors associated with mucosal involvement.

Main Results:

• 26.8% of patients had mucosal involvement, primarily oral, genital, and ocular.
• Patients with mucosal involvement were younger, had higher malignancy history, and more severe phenotypes (hospitalization, infections, corticosteroid needs, BPDAI scores, head/neck, hands/feet involvement).
• Head/neck and acral involvement, higher BPDAI scores, and lower peripheral eosinophilia were independently associated with mucosal involvement.

Conclusions:

• Mucosal involvement in BP correlates with a more severe clinical phenotype.
• Head/neck, acral involvement, higher BPDAI scores, and reduced peripheral eosinophilia are clinical indicators for mucosal assessment and intensive monitoring in BP.