Proportion of Co-morbidities in Patients with and without Bullous Pemphigoid: A Cross-sectional Study

Introduction: Bullous Pemphigoid (BP) is the most common subepidermal immunobullous disorder. It has been found to be associated with various co-morbidities. Only a few studies have been done previously, to find out the association between BP and these co-morbidities. A better understanding of the various co-morbidities in BP patients, enables to implement better treatment strategies, which will be more efficacious and less toxic.

Aim: To compare the proportion of co-morbidities in patients with and without BP and to study the triggering factors associated with BP.

Materials and Methods: This was a hospital based cross-sectional study conducted in the Department of Dermatology and Venereology at Government Medical College and Hospital, Trivandrum, Kerala, India. The duration of the study was one year and six months, from January 2020 to June 2021. A total of 80 patients were included in the present study, out of which 40 patients with BP were included in case group and 40 patients without BP in control group. Clinical data such as age, gender, habits, co-morbidities and factors triggering BP were recorded. Categorical and quantitative variables were expressed as frequency (percentage) and mean±SD respectively. Chi-square test and Fisher’s-exact test were used to find association between categorical variables and (p-value<0.05) was considered as statistically significant.

Results: The mean age of the study participants was 60.8±10.5 years. A total of 23 (57.5%) patients and 20 (50%) normal subjects had a history of co-morbid illness. Diabetes, hypertension, neurological disorders, Coronary Artery Disease (CAD) and Chronic Kidney Disease (CKD) were the co-morbidities reported by the patients. Diabetes was the most commonly observed co-morbidity among the patients. A statistically significant difference was noted between the case and control group in terms of diabetes (p-value=0.039) and neurological disorders (p-value=0.011). A total of 34 (85%) patients had atleast one factor which triggered the onset of the disease, and the most common triggering factor was drug intake in 22 (55%) patients.

Conclusion: The most commonly observed co-morbidity among patients with BP in the present study was diabetes. A prompt surveillance and adequate control of glycaemic status is needed in these patients in order to avoid further worsening of diabetes with corticosteroid therapy. Avoidance of various exogenous triggers such as disease worsening drugs, stress, excessive sun exposure etc., will help in achieving better control of the disease.