Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients

BACKGROUND: Although rare, bullous pemphigoid (BP) is the most common autoimmune blistering disease. Recent studies have shown that patients with bullous pemphigoid are more likely to have neurological and psychiatric diseases, particularly prior to the diagnosis of bullous pemphigoid. OBJECTIVE: The aims were: (i) to evaluate the demographic and clinical features of bullous pemphigoid from a database of patients at a Portuguese university hospital and (ii) to compare the prevalence of comorbid conditions before the diagnosis of bullous pemphigoid with a control group. METHODS: Seventy-seven patients with bullous pemphigoid were enrolled in the study. They were compared with 176 age- and gender-matched controls, which also had the same inpatient to outpatient ratio, but no history of bullous or cutaneous malignant disease. Univariate and multivariate analyses were used to calculate odds ratios for specific comorbid diseases. RESULTS: At least one neurologic diagnosis was present in 55.8% of BP patients compared with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in 35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25 (2.71-10.16); and Parkinson's disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using multivariate analysis, all diseases except Parkinson's retained their association with BP. Patients under systemic treatment were eight times more likely to have complications than those treated with topical steroids (p< 0.017). CONCLUSIONS: The results of this study substantiate the association between BP and neurological diseases. In addition, they highlight the potential complications associated with the treatment of BP

Chemical Methods for Detection of Allergens and Skin Exposure

Many allergens are widely used in both consumer and occupational products. In many cases, it is difficult to know all the ingredients of a product since most products are not sufficiently labelled. To diagnose and prevent allergic contact dermatitis, the demonstration of allergens in the products from the patient’s environment is important. Chemical analysis of a product can make it possible to demonstrate the presence or absence of known allergens. Simple spot tests or documented analytical methods such as thin-layer chromatography (TLC), high-performance liquid chromatography (HPLC), gas chromatography (GC), atomic absorption spectrophotometry (AAS), and inductively coupled plasma-mass spectrometry (ICP-MS) can be used. Moreover, with chemical methods, the purity of a substance can be checked and new allergens can be isolated and identified. Advanced methods such as mass spectrometry (MS), nuclear magnetic resonance spectroscopy (NMR), and infrared spectrophotometry (IR) are often required to identify isolated allergens