Statin use, skin infections, valvular heart disease decreases survival in patients with bullous pemphigoid

Topical corticosteroid treatment was associated with increased overall survival in these patients (10-year survival rate of 31.3%). These identified factors may help dermatologists reduce disease mortality by identifying high-risk patients.

Bullous pemphigoid is a skin disease characterized by the formation of spontaneous blisters due to the production of abnormal antibodies by the patient's immune system (autoimmune disease). Since it is the most common autoimmune blistering skin disease associated with high mortality and increasing incidence, identifying predictors for the survival of these patients holds importance.

Against the above background, Cristian Papara, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Germany, and colleagues aimed to determine the overall survival rate and prognostic factors in bullous pemphigoid in a retrospective cohort study. According to the authors, the study is the first to assess survival and prognostic factors of bullous pemphigoid in Romania.

The study involved newly diagnosed bullous pemphigoid patients in Romania between 2001 and 2019 in a referral unit for autoimmune blistering skin diseases. One hundred forty-eight patients were included in the study.

The study led to the following findings:

• The Kaplan-Meier overall survival rates at 1, 3, 5 and 10 years were 74.2%, 53.4%, 43.6% and 31.3% respectively.
• The median follow-up among survivors was 48 months.
• 60.8% of patients died during the follow-up period; 42.2% had active disease at the time of death.
• Advanced age, valvular heart disease, neurological diseases, malignancies, use of statins, skin infections and extensive cutaneous involvement were linked to poorer outcomes. In contrast, topical corticosteroid use was associated with increased overall survival.

This study, however, lacked a control cohort to validate the obtained results. It was conducted retrospectively in a single centre. In addition, indirect immunofluorescence microscopy was not performed in all patients.

"We identified cardiac and neurological diseases, malignancy, the extent of skin involvement, and advanced age as predictors of decreased survival in bullous pemphigoid," the researchers wrote.

"We found for the first time that valvular heart disease and skin infections at diagnosis were independent risk factors for reduced survival in bullous pemphigoid." They added, "We also observed that topical corticosteroids were linked with increased overall survival. In contrast, using statins was linked to lower survival rates."

"Our findings may aid dermatologists in reducing bullous pemphigoid mortality by identifying high-risk patients and managing them accordingly," the team concluded.

Reference:

Papara C, Chiorean R, Leucuta D, Baican C, Danescu S, Sitaru C, et al. Survival and prognostic factors in bullous pemphigoid: A retrospective cohort study. Indian J Dermatol Venereol Leprol 2023;89:363-71.