University of Oulu

Försti, A‐K, Huilaja, L, Schmidt, E, Tasanen, K. Neurological and psychiatric associations in bullous pemphigoid—more than skin deep?. Exp Dermatol. 2017; 26: 1228– 1234.

Neurological and psychiatric associations in bullous pemphigoid-more than skin deep?

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Author: Försti, Anna-Kaisa1,2; Huilaja, Laura1,2; Schmidt, Enno3;
Organizations: 1PEDEGO Research Unit, University of Oulu, Oulu, Finland
2Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu University Hospital, Oulu, Finland
3Department of Dermatology, University of Lübeck, Lübeck, Germany
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: John Wiley & Sons, 2017
Publish Date: 2019-10-28


In elderly patients, bullous pemphigoid (BP) is associated with several comorbidities; the strongest association occurs between BP and neurological diseases. Different types of dementia, Parkinson’s disease, cerebrovascular disorders and epilepsy all have a significant association with BP, but patients with multiple sclerosis have the highest risk of BP. An existing neurological disorder appears to increase the risk for subsequent BP, but an increased risk for developing some neurological diseases has also been reported following BP diagnosis. BP seems to be associated with several psychiatric diseases such as schizophrenia, uni‐ and bipolar disorder, schizotypal and delusional disorders, and personality disorders, but the risk ratios are usually lower than with neurological diseases. In addition to the skin, the BP autoantigens BP180 and BP230 are expressed in the central nervous system. This finding together with the strong epidemiological association between neurological disorders and BP has led to an assumption that neurodegeneration or neuroinflammation could lead to a cross‐reactive immunoresponse between neural and cutaneous antigens and the failure of self‐tolerance. A subpopulation of patients with Alzheimer’s disease or Parkinson’s disease have circulating IgG autoantibodies against BP180, but currently their significance for the development of BP is unclear, because these antineural BP180 antibodies neither bind to the cutaneous basement membrane nor cause BP‐like symptoms. Further studies analysing large and well‐characterized populations of neurological and psychiatric patients are required to understand better the role of autoimmunization against neural BP autoantigens in the pathogenesis of BP.

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Series: Experimental dermatology
ISSN: 0906-6705
ISSN-E: 1600-0625
ISSN-L: 0906-6705
Volume: 26
Issue: 12; SI
Pages: 1228 - 1234
DOI: 10.1111/exd.13401
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Copyright information: © 2017 John Wiley & Sons A/S. This is the peer reviewed version of the following article: Försti, A‐K, Huilaja, L, Schmidt, E, Tasanen, K. Neurological and psychiatric associations in bullous pemphigoid—more than skin deep?. Exp Dermatol. 2017; 26: 1228– 1234., which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.