Frequency and Correlation of Peripheral and Tissue Eosinophilia With Clinical Manifestations in Patients With Bullous Pemphigoid

Frequency and Correlation of Peripheral and Tissue Eosinophilia With Clinical Manifestations in Patients With Bullous Pemphigoid

Authors

  • Bahareh Abtahi-Naeini Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  • Farhad Zare-Mehrjerdi Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
  • Zabihollah Shahmoradi Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  • Fereshte Rastegarnasab Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mojtaba Akbari Department of Epidemiology, School of Health, Isfahan University of Medical Sciences, Iran
  • Azadeh Zolfaghari Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  • Asiyeh Heidari Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  • Fateme Mohaghegh Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Keywords:

bullous pemphigoid, eosinophilia, eosinophils, BPDAI

Abstract

Introduction: Bullous pemphigoid (BP) is an autoimmune disease involving the sub-epidermal layer. Eosinophilia may play a role in the pathogenesis of BP.

Objectives: We aimed to investigate the correlation between dermal or peripheral eosinophilia with clinical presentations in patients with BP.

Methods: This cross-sectional study was conducted on 108 BP patients from January 2010 to September 2019. Clinical data were recovered. Skin biopsies were re-evaluated, and the Bullous Pemphigoid Disease Area Index (BPDAI) severity score was calculated. Finally, the relationship between clinical features of BP and dermal or peripheral eosinophilia was analyzed.

Results: A total number of 108 patients were included in this study. Thirty-five were excluded due to our exclusion criteria. Finally, data from 73 patients were analyzed. 57.5% of the population was female. There was a significant direct correlation (r= 0.33) between BPDAI severity score and tissue eosinophilia (p= 0.03). No significant relationship was found between BPDAI severity score and peripheral eosinophilia (P= 0.52). There were significant positive correlations between tissue eosinophilia with absolute serum eosinophil count (P= 0.002; r= 0.49) and percentage (P< 0.0001; r= 0.89).

Conclusion: This study revealed significant relationships between tissue eosinophilia and BP severity. These findings could be useful in clinical practice. The possible role of eosinophils in BP clinical features should be considered as a promising help for better diagnosis and treatment.

References

Colbert RL, Allen DM, Eastwood D, Fairley JA. Mortality rate of bullous pemphigoid in a US medical center. Journal of investigative dermatology. 2004;122(5):1091-5.

Miyamoto D, Santi CG, Aoki V, Maruta CW. Bullous pemphigoid. An Bras Dermatol. 2019;94(2):133-46.

Murrell DF, Daniel BS, Joly P, Borradori L, Amagai M, Hashimoto T, et al. Definitions and outcome measures for bullous pemphigoid: recommendations by an international panel of experts. Journal of the American Academy of Dermatology. 2012;66(3):479-85.

Bernard P, Antonicelli F. Bullous pemphigoid: a review of its diagnosis, associations and treatment. Am J Clin Dermatol. 2017;18(4):513-28.

Amber KT, Valdebran M, Kridin K, Grando SA. The role of eosinophils in bullous pemphigoid: a developing model of eosinophil pathogenicity in mucocutaneous disease. Frontiers in medicine. 2018;5:201.

Kridin K. Peripheral eosinophilia in bullous pemphigoid: prevalence and influence on the clinical manifestation. Br J Dermatol. 2018;179(5):1141-7.

Engineer L, Bhol K, Kumari S, Ahmed AR. Bullous pemphigoid: interaction of interleukin 5, anti-basement membrane zone antibodies and eosinophils. A preliminary observation. Cytokine. 2001;13(1):32-8.

Marzano A, Tedeschi A, Fanoni D, Bonanni E, Venegoni L, Berti E, et al. Activation of blood coagulation in bullous pemphigoid: role of eosinophils, and local and systemic implications. Br J Dermatol. 2009;160(2):266-72.

Fudge JG, Crawford RI. Bullous pemphigoid: a 10-year study of discordant results on direct immunofluorescence. J Cutan Med Surg. 2018;22(5):472-5.

Farnaghi F, Ehsani AH, Kamyab-Hesary K, Abbasian S, Seirafi H, Nasimi M. Correlation of dermal and blood eosinophilia with bullous pemphigoid disease severity. Int J Womens Dermatol. 2020;6(3):171-5.

Masmoudi W, Vaillant M, Vassileva S, Patsatsi A, Quereux G, Moltrasio C, et al. International validation of the Bullous Pemphigoid Disease Area Index severity score and calculation of cut‐off values for defining mild, moderate and severe types of bullous pemphigoid. British Journal of Dermatology. 2021;184(6):1106-12.

Billings SD, Cotton J. Inflammatory Dermatopathology: Springer; 2011.

Pasman EA, Heifert TA, Nylund CM. Esophageal squamous papillomas with focal dermal hypoplasia and eosinophilic esophagitis. World J Gastroenterol. 2017;23(12):2246.

Nishioka K, Hashimoto K, Katayama I, Sarashi C, Kubo T, Sano S. Eosinophilic spongiosis in bullous pemphigoid. Arch Dermatol. 1984;120(9):1166-8.

Dvorak AM, Mihm Jr MC, Osage JE, Kwan TH, Austen KF, Wintroub BU. Bullous pemphigoid, and ultrastructural study of the inflammatory response: Eosinophil, basophil and mast cell granule changes in multiple biopsies from one patient. J Invest Dermatol. 1982;78(2):91-101.

Bushkell LL, Jordon RE. Bullous pemphigoid: a cause of peripheral blood eosinophilia. J Am Acad Dermatol. 1983;8(5):648-51.

Lin L, Hwang B-J, Culton DA, Li N, Burette S, Koller BH, et al. Eosinophils mediate tissue injury in the autoimmune skin disease bullous pemphigoid. J Invest Dermatol. 2018;138(5):1032-43.

Wakugawa M, Nakamura K, Hino H, Toyama K, Hattori N, Okochi H, et al. Elevated levels of eotaxin and interleukin‐5 in blister fluid of bullous pemphigoid: correlation with tissue eosinophilia. Br J Dermatol. 2000;143(1):112-6.

Ganji R, Diab R, Mousavi F, Abdollahimajd F. Recalcitrant course of bullous pemphigoid indicating coexisting hypereosinophilic syndrome: A case report and literature review. Clin Case Rep. 2023;11(6):e7384.

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Published

2024-07-31

How to Cite

1.
Frequency and Correlation of Peripheral and Tissue Eosinophilia With Clinical Manifestations in Patients With Bullous Pemphigoid. Dermatol Pract Concept [Internet]. 2024 Jul. 31 [cited 2024 Dec. 5];14(3):e2024169. Available from: https://www.dpcj.org/index.php/dpc/article/view/4071

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