Depression and Anxiety in Patients with Bullous Pemphigoid : Impact and Management Challenges

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. It is also associated with high mortality and poor prognosis due to advanced age of the patients and coexisting comorbidities. There is a dearth of data in the literature regarding depression and anxiety among those patients. The objective of this brief review is to discuss the intertwining relationship between depression and anxiety with bullous pemphigoid.Peer reviewe

Bullous Pemphigoid in Three Paediatric Patients in Finland

Non peer reviewe

Granuloma Annulare and Morphea : Correlation with Borrelia burgdorferi Infections and Chlamydia-related Bacteria

A retrospective study of 109 skin biopsies with granuloma annulare (GA) or morphea histology from patients with suspected tick bite was performed. Biopsies were tested for cutaneous Borrelia burgdorferi DNA using PCR. The same biopsies were analysed for tick-borne novel agents, Chlamydia-related bacteria (members of the Chlamydiales order), using a PCR-based method. Borrelia DNA was detected in 7/73 (9.6%) biopsies with GA and in 1/36 (2.8 %) biopsies with morphea, while Chlamydiales DNA was found in 53/73 (72.6%) biopsies with GA and 25/34 (73.4%) biopsies with morphea. All Borrelia DNA-positive GA samples were also positive for Chlamydiales DNA. The Chlamydiales sequences detected in GA were heterogeneous and contained Waddliaceae and Rhabdochlamydiaceae bacteria, which are also present in Ixodes ricinus ticks, while the Chlamydiales sequences detected in morphea closely resembled those found in healthy skin. In conclusion, tick-mediated infections can trigger GA in some cases, while correlation of either Borrelia or Chlamydiales with morphea is unlikely.Peer reviewe

The Many Faces of Solitary and Multiple Erythema Migrans

Peer reviewe

Bullous pemphigoid-associated chronic atrophic gastritis

Non peer reviewe

Accurate diagnosis of bullous pemphigoid requires multiple health care visits

Abstract Introduction: Accurate use of diagnostic codes is crucial for epidemiological and genetic research based on electronic health record (EHR) data. Methods: This retrospective study validated the International Classification of Diseases (ICD)-10 diagnostic code L12.0 for bullous pemphigoid (BP) using EHR data from two Finnish university hospitals. We found 1225 subjects with at least one EHR entry of L12.0 between 2009 and 2019. BP diagnosis was based on clinical findings characteristic of BP and positive findings on direct immunofluorescence (DIF), BP180-NC16A enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence (IIF) assay. Results: True BP was found in 901 patients; the positive predictive value (PPV) for L12.0 was 73.6% (95% CI 71.0-76.0). L12.0 was more accurately registered in dermatology units than any specialized health care units (p<0.001). Including patients with multiple L12.0 registrations (≥3), increased the accuracy of the L12.0 code in both dermatology units and other settings. Discussion: One diagnostic code of L12.0 is not enough to recognize BP in a large epidemiological data set; including only L12.0 registered in dermatology units and excluding cases with <3 L12.0 record entries markedly increases the PPV of BP diagnosis.Abstract Introduction: Accurate use of diagnostic codes is crucial for epidemiological and genetic research based on electronic health record (EHR) data. Methods: This retrospective study validated the International Classification of Diseases (ICD)-10 diagnostic code L12.0 for bullous pemphigoid (BP) using EHR data from two Finnish university hospitals. We found 1225 subjects with at least one EHR entry of L12.0 between 2009 and 2019. BP diagnosis was based on clinical findings characteristic of BP and positive findings on direct immunofluorescence (DIF), BP180-NC16A enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence (IIF) assay. Results: True BP was found in 901 patients; the positive predictive value (PPV) for L12.0 was 73.6% (95% CI 71.0-76.0). L12.0 was more accurately registered in dermatology units than any specialized health care units (p<0.001). Including patients with multiple L12.0 registrations (≥3), increased the accuracy of the L12.0 code in both dermatology units and other settings. Discussion: One diagnostic code of L12.0 is not enough to recognize BP in a large epidemiological data set; including only L12.0 registered in dermatology units and excluding cases with <3 L12.0 record entries markedly increases the PPV of BP diagnosis

Treatment of bullous pemphigoid with methotrexate is associated with a decreased mortality risk

Dear Editor, Patients with bullous pemphigoid (BP) have a markedly increased risk of death compared with age- and sex-matched controls.1 Previous studies on mortality risk factors in BP have been based on relatively small sample sizes and have returned inconsistent and partly contradictory findings.2 Concerning treatments, long-term use of high doses of systemic corticosteroids (SCS) clearly contributes to increased mortality and morbidity.1 The present registry study was designed to retrospectively evaluate mortality, and to examine its predictive factors, in a large BP cohort in a real-world setting. This study was based on data from the electronic health records of Helsinki and Oulu University Hospitals in Finland.Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, which typically affects the elderly and causes an increased risk for death. This retrospective study of data from electronic health records of two Finnish university hospitals showed that treatment with methotrexate was associated with a significantly reduced mortality of patients with BP compared with those treated with other drugs. In addition, we found that advanced age at diagnosis, concomitant type 2 diabetes, dementia and mean value of circulating BP180 antibodies >= 60 U mL-1 were predictors for a poor outcome.Peer reviewe