Zhang Yu, Luo Yang, Han Yue, Tian Rong, Li Wei, Yao Xu
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
Department of Dermatology, General Hospital of the Air Force, Beijing, China.
J Dermatol. 2017 Jul;44(7):742-746. doi: 10.1111/1346-8138.13782. Epub 2017 Mar 3.
The aim of the present study was to explore the clinical and histopathological characteristics and treatment of patients with bullous pemphigoid (BP) that initially manifested as non-bullous lesions and provide information for early diagnosis and improved treatment. Medical records of 491 cases of BP were collected. The clinical and histopathological characteristics, treatment and outcomes of patients who initially presented with non-bullous lesions (prodromal BP, PBP) were analyzed and compared with those from patients who initially presented with bullous lesions (classical BP, cBP). Of the BP patients studied, 36.8% had PBP and presented with diversified initial lesions before the appearance of typical bullae, with erythema as the most frequent (31.67%), followed by concurrent erythema and papules (30.4%). The mean duration before bullae appearance was 15.91 ± 0.65 months. The degree of itch in PBP patients was higher than that in cBP patients. There was no difference in the hospital stay and time to disease control between the PBP and cBP patients. However, the mean glucocorticoid dose for control of the lesions in PBP patients was significantly higher than that in cBP patients. In addition, the PBP patients experienced side-effects more frequently than did the cBP patients (87.85% vs 17.41%). In conclusion, intensive treatment is required for PBP patients due to delayed diagnosis and advanced development of the disease. Itching, concurrent erythema and papules occurring in the elderly may be clues for the early diagnosis of PBP.
本研究的目的是探讨初始表现为非水疱性皮损的大疱性类天疱疮（BP）患者的临床和组织病理学特征及治疗方法，为早期诊断和改善治疗提供信息。收集了491例BP患者的病历。分析并比较了初始表现为非水疱性皮损（前驱性BP，PBP）的患者与初始表现为水疱性皮损（经典BP，cBP）的患者的临床和组织病理学特征、治疗及结局。在所研究的BP患者中，36.8%为PBP，在典型水疱出现前有多种初始皮损，其中红斑最为常见（31.67%），其次是红斑和丘疹同时出现（30.4%）。水疱出现前的平均持续时间为15.91±0.65个月。PBP患者的瘙痒程度高于cBP患者。PBP患者和cBP患者的住院时间和疾病控制时间无差异。然而，PBP患者控制皮损所需的平均糖皮质激素剂量显著高于cBP患者。此外，PBP患者比cBP患者更频繁地出现副作用（87.85%对17.41%）。总之，由于疾病诊断延迟和病情进展，PBP患者需要强化治疗。老年人出现瘙痒、同时伴有红斑和丘疹可能是PBP早期诊断的线索。
