Bullous pemphigoid and its association with neurological diseases.

Background: Bullous Pemphigoid (BP) is the most common immunobullous skin disease. Methods: This was a descriptive cross-sectional study of electronic health records data at a specialist dermatology clinic at Tygerberg Hospital in the Western Cape. Patients presenting during a predefined 5-year period with a clinicopathologic diagnosis of BP were included. Results: The final sample comprised 54 cases of BP. The median age at diagnosis was 71.0 years, and 64.8% were female. Eighty per cent had at least one chronic medical condition at the time of BP diagnosis. The most common comorbidities were hypertension (63.0%), diabetes mellitus (33.3%) and strokes (24.1%). Twenty-eight per cent had been diagnosed with at least one neurological comorbidity at the time of BP diagnosis. Patients experienced a median delay of 45 days (interquartile range: 21.0-90.0 days) between onset of symptoms and presentation to dermatology. Conclusion: This is the first study reporting co-morbidities in patients with BP in sub-Saharan Africa. Despite the high burden of disease due to physical injury in the study setting, no patients with BP had a history of traumatic brain injury. This suggests the possibility that the association between BP and neurologic disorders is limited to stroke, epilepsy, and neurodegenerative diseases. Future prospective cohort studies are indicated to further investigate the results of this study. Contribution: To describe neurologic and other comorbidities in patients presenting with BP at a tertiary hospital in South Africa. This research in South Africa, a lower-middle-income country, seeks to address knowledge gaps, utilize data, and advance the field of dermatology.