Trigger factors associated with bullous autoimmune dermatoses

摘要

Background: Blistering autoimmune dermatoses are a heterogeneous group of rare diseases. Pemphigus diseases are distinguished from pemphigoid diseases as well as dermatitis herpetiformis. In pemphigus diseases, cutaneous blistering is caused by an intraepidermal loss of adhesion between keratinocytes. In pemphigoid diseases, blister formation is due to a subepidermal loss of adhesion of keratinocytes from the basement membrane. Objectives: This article reviews the most important trigger factors associated with bullous autoimmune dermatoses and discusses their role in their initial manifestation as well as exacerbation. Materials and methods: A focused review of the literature including original articles, guidelines, reference works and previously published review articles was performed. Results: Vaccinations, viral infections, ultraviolet light (UV) exposure and radiation therapies are possible triggers of pemphigus vulgaris in predisposed patients. For the much rarer pemphigus foliaceus, UV exposure is of particular importance. Thiols and phenols are drugs that can induce pemphigus usually resembling pemphigus foliaceus clinically. Age is the most important risk factor of bullous pemphigoid. In addition, in bullous pemphigoid associations with dipeptidyl peptidase 4 inhibitors, programmed cell death protein-1 or programmed death-ligand-1 inhibitors as well as neurological diseases are particularly relevant. Severe mucosal damage, certain drugs and in particular cases neoplasms might play a role in mucous membrane pemphigoid. Conclusion: Knowing possible trigger factors facilitates a timely diagnosis upon initial manifestation and supports the prevention of relapse of bullous autoimmune dermatoses.