Patients with certain neurological and psychiatric disorders have an increased risk for developing bullous pemphigoid.

The autoantibodies associated with bullous pemphigoid (BP180 or BPAg1) often react with the intercellular part of the hemidesmosome. Patients with certain neurologic diseases have increased levels of these autoantibodies in serum. The authors of two recent studies identified a possible clinical link between bullous pemphigoid and neurologic disease.


Langan and colleagues conducted a case-control study using computerized medical records from a large, population-based, general practice database in the U.K. Of 3453 patients with neurologic disease, bullous pemphigoid was diagnosed in 868 patients. The researchers found significantly increased risk for pemphigoid in patients with stroke, dementia, Parkinson disease, epilepsy, and multiple sclerosis. The associations were significant only when the neurologic disease was diagnosed before pemphigoid.

Bastuji-Garin et al. performed a prospective, multicenter study of 201 patients with incident bullous pemphigoid and 345 controls matched for age, sex, center, and place of residence. Univariate and multivariate logistic regression analyses were used to compare drugs used, comorbidities, and physical and cognitive impairments in cases and controls. The researchers found significant independent associations of bullous pemphigoid with major cognitive impairment, Parkinson disease, and unipolar or bipolar disorder. Increased risk was also associated with spironolactone and with phenothiazines with aliphatic side chains.


Citation(s):

Langan SM et al. The relationship between neurological disease and bullous pemphigoid: A population-based case-control study. J Invest Dermatol 2011 Mar; 131:631.

Bastuji-Garin S et al. Risk factors for bullous pemphigoid in the elderly: A prospective case-control study. J Invest Dermatol 2011 Mar; 131:637.