Department of Dermatology, Emory University School of Medicine, 1365 Clifton Rd NE, Ste 1100, Building A, Atlanta, GA 30322, USA.
Clin Dermatol. 2011 Jan-Feb;29(1):69-79. doi: 10.1016/j.clindermatol.2010.07.010.
Autoimmune blistering diseases are a significant cause of morbidity and mortality in the elderly population. Given the advancing age of the population, the incidence of these disorders, particularly bullous pemphigoid, is expected to rise. This contribution reviews autoimmune immunobullous disorders of particular relevance in the elderly population. These include bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita, pemphigus, paraneoplastic pemphigus, and linear immunoglobulin A bullous dermatosis. Because therapy and management of individual immunobullous dermatoses differ, establishing the diagnosis is often critically important. An overall approach to bullous diseases in the elderly, as well as key clinical features, appropriate diagnostic tests, microscopic findings, immunofluorescence microscopy patterns, and molecular targets for select disorders are reviewed. Elucidation of antigenic targets at the molecular level has allowed for development of serum enzyme-linked immunofluorescence assays, which have enhanced diagnostic accuracy for several autoimmune blistering disorders. Given the relative rarity of these diseases, large randomized trials evaluating efficacy of various treatments are few, and therapy for most immunobullous disorders in the elderly has not been standardized. Despite this, appropriate therapeutic considerations for each condition are presented and the evidence for them is reviewed.
自身免疫性水疱病是老年人群发病率和死亡率的重要原因。鉴于人口老龄化，这些疾病的发病率，特别是大疱性类天疱疮，预计将会上升。这篇文章回顾了老年人中特别相关的自身免疫性免疫性水疱病。这些疾病包括大疱性类天疱疮、瘢痕性类天疱疮、获得性大疱性表皮松解症、天疱疮、副肿瘤性天疱疮和线性 IgA 大疱性皮病。由于个体免疫性水疱病的治疗和管理不同，因此确定诊断通常至关重要。本文回顾了老年人大疱性疾病的整体方法以及关键的临床特征、适当的诊断测试、显微镜下发现、免疫荧光显微镜模式以及特定疾病的分子靶标。在分子水平阐明抗原靶标，使得开发出几种自身免疫性水疱病的血清酶联免疫荧光分析检测方法，提高了诊断的准确性。鉴于这些疾病相对罕见，评估各种治疗效果的大型随机试验很少，而且老年人的大多数免疫性水疱病的治疗尚未标准化。尽管如此，本文还是为每种疾病提出了适当的治疗考虑，并回顾了相关证据。
