Bernard et al identified risk factors for relapse in a patient with bullous pemphigoid who has achieved a clinical remission following therapy. These can help to identify a patient who may benefit from ongoing therapy. The authors are from multiple hospitals in France.


Patient selection: bullous pemphigoid treated with corticosteroids


Outcome: relapse in the 12 months following clinical remission (most of which occurred during the first 3 months after stopping therapy)


Criteria for remission:

(1) absence of blisters, erosions and pruritic erythematous eruptions

(2) for at least 3 months


Criteria for relapse:

(1) appearance of new bullae daily for several consecutive days

(2) reappearance of pruritis and erythema


Findings on day 0 (day corticosteroids stopped) associated with relapse:

(1) positive direct immunofluorescence (performed on 4 mm punch biopsy from flexural aspect of arm or thigh)

(2) high titer (>= 27 IU/mL) ELISA score for autoantibodies to BP180



• 27 IU on the ELISA assay was 3 times the upper limit of the normal reference range.

• The ELISA assay target was the NC-16A domain of BP180 and the assay was from MBL Co, Ltd in Nagoya, Japan.


Older age was associated with relapse, with mean age for those who relapsed being 82.2 (+/- 7.8) years versus 77 (+/- 10.1) years for those who continued in remission.


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