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Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Mucosal Involvement in Bullous Pemphigoid: Severity Indicator and Associated Clinical Features from a Retrospective
Shengnan Cui1, Bingjie Zhang1, Fangyuan Chen1
1Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
Purpose:
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder. Although mucosal involvement is uncommon, it may indicate a more severe clinical phenotype. This study evaluated the prevalence and clinical features associated with mucosal involvement in BP.
Patients And Methods:
This retrospective cohort study included 265 patients with BP diagnosed at Peking Union Medical College Hospital between January 2013 and May 2022. Clinical, laboratory, immunological, and treatment-related characteristics were compared between patients with and without mucosal involvement. Logistic regression analyses were performed to identify factors associated with mucosal involvement, and model performance was assessed using receiver operating characteristic analysis.
Results:
Seventy-one patients (26.8%) had mucosal involvement, most commonly affecting the oral mucosa, followed by genital and ocular sites. Compared with patients without mucosal lesions, those with mucosal involvement were younger at disease onset, more frequently had a history of malignancy, and showed a more severe clinical phenotype, including higher hospitalization rates, more infections within 1 year, higher corticosteroid requirements, higher BPDAI scores, and more frequent head/neck and hands/feet involvement. Indirect immunofluorescence seropositivity and peripheral eosinophilia were less frequent in patients with mucosal involvement. In multivariate analysis, head/neck involvement (adjusted OR 8.276, 95% CI 2.211-30.977), hands/feet involvement (adjusted OR 34.559, 95% CI 8.191-145.805), and higher BPDAI score (adjusted OR 1.055, 95% CI 1.020-1.091) were independently associated with mucosal involvement, whereas peripheral eosinophilia was inversely associated (adjusted OR 0.027, 95% CI 0.005-0.148). The model demonstrated excellent apparent discrimination (AUC 0.937).
Conclusion:
Mucosal involvement in BP is associated with a more severe clinical phenotype. Head/neck and acral involvement, higher BPDAI scores, and a lower frequency of peripheral eosinophilia may serve as practical clinical indicators for identifying patients who require closer mucosal assessment and more intensive monitoring.
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