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• W4283723492 abstract "To the Editor: I read with interest the article by Guerrois et al1Guerrois F, Hassan E, Bettuzzi T, et al. Bullous pemphigoid: three main clusters defining 3 outcome profiles. J Am Acad Dermatol. Published online April 26, 2022. https://doi.org/10.1016/j.jaad.2022.04.029Google Scholar on 3 main clusters of bullous pemphigoid (BP). They performed hierarchical clustering on the principal components and identified 3 main clusters of BP. On one hand, patients in cluster 1 were older and had fewer blisters and a higher frequency (87%) of anti-BP230 antibodies than that of patients in the other 2 clusters. On the other hand, more than 70% of the patients in clusters 2 and 3 had only anti-BP180 antibodies. In addition, patients in cluster 3 had significantly higher frequencies of more than 100 blisters and mucosal involvement. Therefore, they needed more systemic treatments and had more relapses. These results are mostly consistent with the clinical observations in daily practice. However, the clusters of patients with BP might be more complex than those identified in the study. Recent studies have demonstrated that antihyperglycemic drugs, dipeptidyl peptidase 4 (DPP4) inhibitors, may be a risk of developing BP.2Salemme A. Fania L. Scarabello A. et al.Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP 180 and -BP230 humoral response: results of a multicenter study.J Am Acad Dermatol. 2022; 87: 56-63https://doi.org/10.1016/j.jaad.2022.02.036Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3Ständer S. Schmidt E. Zillikens D. Ludwig R.J. Kridin K. More severe erosive phenotype despite lower circulating autoantibody levels in depeptidyl peptidase-4 inhibitor (DPP4i)-assoicated bullous pemphigoid: a retrospective cohort study.Am J Clin Dermatol. 2021; 22: 117-127Crossref PubMed Scopus (9) Google Scholar DPP4 inhibitor–associated BP has peculiar presentations. Patients with DPP4 inhibitor–associated BP usually show a noninflammatory phenotype, which means a lower amount of circulating and infiltrating eosinophils,2Salemme A. Fania L. Scarabello A. et al.Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP 180 and -BP230 humoral response: results of a multicenter study.J Am Acad Dermatol. 2022; 87: 56-63https://doi.org/10.1016/j.jaad.2022.02.036Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar but can have a more severe presentation of blisters and erosions.3Ständer S. Schmidt E. Zillikens D. Ludwig R.J. Kridin K. More severe erosive phenotype despite lower circulating autoantibody levels in depeptidyl peptidase-4 inhibitor (DPP4i)-assoicated bullous pemphigoid: a retrospective cohort study.Am J Clin Dermatol. 2021; 22: 117-127Crossref PubMed Scopus (9) Google Scholar The frequency and titers of immunoglobulin G autoantibodies to BP180 and BP230 are usually lower in these patients with DPP4 inhibitor–associated BP than in other patients with BP.2Salemme A. Fania L. Scarabello A. et al.Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP 180 and -BP230 humoral response: results of a multicenter study.J Am Acad Dermatol. 2022; 87: 56-63https://doi.org/10.1016/j.jaad.2022.02.036Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3Ständer S. Schmidt E. Zillikens D. Ludwig R.J. Kridin K. More severe erosive phenotype despite lower circulating autoantibody levels in depeptidyl peptidase-4 inhibitor (DPP4i)-assoicated bullous pemphigoid: a retrospective cohort study.Am J Clin Dermatol. 2021; 22: 117-127Crossref PubMed Scopus (9) Google Scholar In addition, the autoantibodies in patients with DPP4 inhibitor–associated BP may target different epitopes of BP180 other than noncollagenous region 16A.2Salemme A. Fania L. Scarabello A. et al.Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP 180 and -BP230 humoral response: results of a multicenter study.J Am Acad Dermatol. 2022; 87: 56-63https://doi.org/10.1016/j.jaad.2022.02.036Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3Ständer S. Schmidt E. Zillikens D. Ludwig R.J. Kridin K. More severe erosive phenotype despite lower circulating autoantibody levels in depeptidyl peptidase-4 inhibitor (DPP4i)-assoicated bullous pemphigoid: a retrospective cohort study.Am J Clin Dermatol. 2021; 22: 117-127Crossref PubMed Scopus (9) Google Scholar These features highlight the characteristics of these patients with DPP4 inhibitor–associated BP and differentiate these patients from other patients with BP. However, it seems that Guerrois et al1Guerrois F, Hassan E, Bettuzzi T, et al. Bullous pemphigoid: three main clusters defining 3 outcome profiles. J Am Acad Dermatol. Published online April 26, 2022. https://doi.org/10.1016/j.jaad.2022.04.029Google Scholar did not include the use of DPP4 inhibitors in their analysis. Therefore, it may possibly make their analysis biased. Detailed information about the patient selection process, including specifying if all consecutive patients with a diagnosis of BP were included and data on patient exposure to DPP4 inhibitors or other BP-associated drugs or factors, would be important. In addition, immunoglobulin E (IgE) autoantibodies also play some roles in the pathogenesis of BP and may contribute to the formation of certain clinical presentations.4van Beek N. Lüttmann N. Huebner F. et al.Correlation of serum levels of IgE autoantibodies against BP 180 with bullous pemphigoid disease activity.JAMA Dermatol. 2017; 153: 30-38Crossref PubMed Scopus (99) Google Scholar,5Cho Y.T. Liao S.L. Wang L.F. Chu C.Y. High serum anti-BP 180 IgE levels correlate to prominent urticarial lesions in patients with bullous pemphigoid.J Dermatol Sci. 2016; 83: 78-80Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar For example, higher titers of anti-BP180 IgE autoantibodies have been linked to more severe clinical lesions and the formation of urticarial lesions or erythemas in patients with BP.5Cho Y.T. Liao S.L. Wang L.F. Chu C.Y. High serum anti-BP 180 IgE levels correlate to prominent urticarial lesions in patients with bullous pemphigoid.J Dermatol Sci. 2016; 83: 78-80Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Furthermore, these patients may have some benefits from the anti-IgE treatments. As a result, the presence and titers of these IgE autoantibodies might be considered to draw a more detailed picture of the disease when analyzing the profiles of patients with BP. Better characterization of the presentations and outcome profiles of patients with BP is an important step toward personalized medicine. This approach can provide a more precise prognosis prediction and a possibly more suitable treatment modality for each patient with BP. To achieve this, a comprehensive analysis to include all current knowledge about BP is usually warranted. None disclosed." @default.
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• W4283723492 title "Comments on “Bullous pemphigoid: Three main clusters defining 3 outcome profiles”" @default.
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