Bullous pemphigoid: Triggering and exacerbating factors in the Polish population

Introduction: Bullous pemphigoid is a blistering disease with a complex aetiology. Various conditions and external factors can disrupt immune tolerance to autoantigens, triggering autoimmunity. It affects people of all ages and sexes, mostly those over 60. Recently, cases among younger individuals have increased. This study aimed to assess potential triggers and exacerbating factors, including age, comorbidities, medications, physical factors, and infections. Material and methods: The study included 40 patients with bullous pemphigoid diagnosed based on immunopathological examination who continued ambulatory treatment for at least 6 months. A retrospective analysis of the medical reports gathered between 2018 and 2019 was performed. Results: Four of the twelve patients with central nervous system disorders experienced exacerbation, and six patients relapsed after discontinuation of pharmacotherapy. Internal disorders, such as arterial hypertension, atrial fibrillation, and diabetes mellitus, are associated with frequent exacerbation and relapse after discontinuation of treatment. One of the four patients treated with furosemide did not achieve remission. Seven of the seventeen patients with a history of trauma experienced exacerbation, while four were diagnosed with relapse after discontinuation of the treatment. Exacerbation was observed in three patients, while relapse after discontinuation of the causal treatment was observed in two patients with viral infections. Conclusions: The outcomes of the present study indicated that comorbidities, medications, trauma, and infections shape the course of bullous pemphigoid, affecting exacerbations, relapses, and remission achievement. The role of internal disorders as risk factors for bullous pemphigoid requires cooperation between dermatologists and physicians from other specialities.