Aged ; Drugs, Chinese Herbal ; Humans ; Male ; Pemphigoid, Bullous ; drug therapy ; Psoriasis ; drug therapy ; Tripterygium ; chemistry

Bullous pemphigoid (BP) is a common autoimmune subepidermal bullous disease.The diagnosis of BP relies on clinical manifestation,histopathology,direct and indirect immunofluorescence,and serological assay.In the past two decades,topical corticosteroids and systemic and/or topical corticosteroids were the major therapeutic options for localized/mild/moderate and extensive/severe BP,respectively.In 2021,several experts from the French Study Group on Autoimmune Bullous Skin Diseases collaboratively issued the updated guidelines for the therapeutic management of BP based on evidence-based medicine.The guidelines fully detailed the updated therapeutic options for extensive BP,BP of limited extent,localized form of BP,corticosteroid-dependent BP,and drug-induced/associated BP.In particular,systemic corticosteroids are no longer the first-line treatment for extensive BP.We interpret the guidelines to assist dermatologists in the comprehensive management of BP and promote the standardization of BP treatment.
Humans ; Pemphigoid, Bullous/drug therapy* ; Autoimmune Diseases/drug therapy* ; Glucocorticoids/therapeutic use* ; Adrenal Cortex Hormones/therapeutic use*

Bullous pemphigoid is a rare nonhematologic autoimmune complication of chronic lymphocytic leukemia. There have been roughly 10 cases worldwide since 1974, and searches through Korean dermatological literature revealed no reported cases. A 72-year-old man had been diagnosed with chronic lymphocytic leukemia and treated with chemotherapy for 7 months. After that, he was in complete remission, and the chemotherapy was discontinued consequently. One month later, multiple erythematous blisters, papules, and crusts developed on his trunk and both extremities. Histopathologic examination and immunofluorescence of the tense blister revealed a bullous pemphigoid. We present this rare case as the first documented case report of bullous pemphigoid following chronic lymphocytic leukemia in the Korean dermatological literature.
Aged ; Blister ; Drug Therapy ; Extremities ; Fluorescent Antibody Technique ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Pemphigoid, Bullous* ; Transcutaneous Electric Nerve Stimulation

OBJECTIVETo evaluate the correlation between blood eosinophil (EOS)level and steroid doses in patients of bullous pemphigoid (BP).

METHODSA total of 82 untreated BP inpatients (n=49) and outpatients (n=33) were enrolled in this study. The blood EOS level and the steroid doses before and after treatment were recorded. The correlation between EOS level and steroid doses was analyzed retrospectively.

RESULTSEOS increased in 69 BP patients (84.15%); on the contrary, only 10% of normal controls had increased EOS (t=1.99,P<0.001). In 44 inpatients, the blood EOS remained high before steroid treatment, and quickly returned to normal level after the disease became stable. There was a linear correlation between EOS and steroid doses (Spearman analysis,r=0.496,P<0.001). In 5 patients who were treated by non-steroid approach, EOS level also declined after the disease was resolved.

CONCLUSIONEOS can be one of useful indicators for the application of steroids in the treatment of BP.

Adult ; Aged ; Aged, 80 and over ; Eosinophils ; Female ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Pemphigoid, Bullous ; drug therapy ; immunology ; Retrospective Studies ; Steroids ; administration & dosage ; therapeutic use

OBJECTIVETo investigate the effect of Jingui Shenqi Pill (JSP) on the expression of glucocorticoid receptor (GR) in the skin lesion and its clinical effect in treating bullous pemphigoid (BP) patients.

METHODSThirty BP patients were randomly divided into the treatment group (n=15) treated with JSP plus prednisone and the prednisone group (n=15) with prednisone alone both for 4 weeks. And a normal control group was set up also. Expressions of GR-alpha and GR-beta in the skin lesion of BP patients and the normal skin of the normal control were detected by immunohistochemical assay. Results The total effective rate was 93.33% in the treatment group, significantly higher than that in the prednisone group which was 73.33% (P < 0.05); GR-alpha expression was higher in the treatment group than that in other two groups (P < 0.01), while GR-beta expression in the treatment group was lower than that in the prednisone group (P < 0.01).

CONCLUSIONJSP could increase GR-alpha expression and decrease GR-beta expression in the skin lesion of BP patients, so as to improve sensitivity of skin to glucocorticoid.

Aged ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Pemphigoid, Bullous ; drug therapy ; metabolism ; pathology ; Phytotherapy ; Prednisone ; therapeutic use ; Receptors, Glucocorticoid ; biosynthesis ; Skin ; drug effects ; metabolism ; pathology ; Treatment Outcome