Brunsting–Perry Cicatricial Pemphigoid (BPCP)

Brunsting–Perry cicatricial pemphigoid (BPCP) is a rare autoimmune skin disease that causes blistering and scarring on the skin and mucous membranes. It is a type of pemphigoid that primarily affects the head and neck area, but can also spread to other parts of the body. BPCP is characterized by the production of antibodies that attack the skin’s basement membrane, leading to blister formation and subsequent scarring. The disease is most commonly seen in older adults, and can have significant functional and cosmetic effects. Treatment typically involves immunosuppressive medications to control the immune response and prevent further damage to the skin.

Causes

The main causes of this condition are:

  1. Autoimmunity: The immune system is responsible for fighting against foreign invaders such as bacteria and viruses. However, in some cases, the immune system attacks the body’s own tissues and organs, leading to autoimmune diseases such as cicatricial pemphigoid. In this condition, the immune system produces antibodies that attack the proteins that hold the skin and mucous membranes together, causing them to separate and form blisters.
  2. Genetics: Cicatricial pemphigoid is believed to have a genetic component. People with a family history of autoimmune disorders are more likely to develop this condition.
  3. Age: Cicatricial pemphigoid is more common in older adults, particularly those over the age of 60.
  4. Gender: Women are more likely to develop cicatricial pemphigoid than men.
  5. Environmental factors: Certain environmental factors may trigger the onset of cicatricial pemphigoid in genetically susceptible individuals. These factors may include exposure to certain drugs, chemicals, or infections.
  6. Other medical conditions: Cicatricial pemphigoid may occur in association with other medical conditions, such as rheumatoid arthritis, lupus, or other autoimmune disorders.
You Might Also Read  Persistent Edema of Rosacea

Overall, the exact cause of cicatricial pemphigoid is not fully understood, and more research is needed to determine the underlying mechanisms and risk factors involved.

Symptoms

The main symptoms of Brunsting-Perry cicatricial pemphigoid include:

  1. Blisters and erosions: One of the most common signs of Brunsting-Perry cicatricial pemphigoid is the formation of small, fluid-filled blisters on the mucous membranes. These blisters can rupture and form painful, open sores (erosions) that take longer than normal to heal.
  2. Scarring: Over time, the erosions may heal, but leave behind scars that can cause permanent damage to the affected mucous membranes. Scarring can lead to complications such as vision loss, difficulty swallowing, and sexual dysfunction.
  3. Itching and burning: Some people with Brunsting-Perry cicatricial pemphigoid may experience itching and burning on the affected areas before blisters or erosions form.
  4. Dry eyes and mouth: Brunsting-Perry cicatricial pemphigoid can also cause dry eyes and mouth, which can be uncomfortable and increase the risk of infection.
  5. Dental problems: In some cases, Brunsting-Perry cicatricial pemphigoid can affect the gums and teeth, leading to periodontal disease, tooth decay, and tooth loss.
  6. Difficulty speaking, eating, and swallowing: If the blisters and scarring affect the mouth and throat, it can make it difficult to speak, eat, and swallow.
  7. Vision problems: If the blisters and scarring affect the eyes, it can cause redness, irritation, and vision loss. In severe cases, blindness may occur.

Diagnosis

Brunsting–Perry cicatricial pemphigoid (also known as mucous membrane pemphigoid) is a rare autoimmune disease that affects the skin and mucous membranes. The main test used to diagnose this condition is a biopsy, which involves removing a small sample of skin or mucous membrane tissue for analysis.

You Might Also Read  Folliculitis Keloidalis Nuchae (FKN)

During the biopsy, a dermatologist or other medical professional will use a local anesthetic to numb the area, and then take a small sample of tissue using a scalpel or punch biopsy tool. The tissue is then sent to a pathology laboratory for examination under a microscope.

The main findings in the biopsy results for Brunsting–Perry cicatricial pemphigoid are the presence of subepithelial blistering, inflammation, and scarring. These changes occur because the immune system produces antibodies that attack the proteins that hold the skin and mucous membranes together, causing them to separate and blister. Over time, the blisters can lead to scarring, which can cause permanent damage and disfigurement.

Other tests that may be used to help diagnose Brunsting–Perry cicatricial pemphigoid include blood tests to look for specific antibodies, skin tests to assess the immune response, and imaging studies to evaluate the extent of the disease. Treatment typically involves medications that suppress the immune system, such as corticosteroids or immunosuppressants, as well as topical ointments to relieve symptoms and promote healing.

Treatment

The main treatment for BPCP is a combination of systemic and topical therapies, as well as supportive measures.

Systemic therapy involves the use of medications that suppress the immune system, such as corticosteroids, immunosuppressive drugs, and biologics. Corticosteroids are the first-line treatment for BPCP and are usually given orally. In severe cases, intravenous corticosteroids may be needed. Immunosuppressive drugs such as azathioprine, mycophenolate mofetil, and cyclophosphamide may be added to corticosteroids to reduce the dose and minimize their side effects. Biologics, such as rituximab and intravenous immunoglobulin, may be used in refractory cases.

You Might Also Read  Gram-Negative rosacea

Topical therapy involves the use of topical corticosteroids and immunomodulators, such as tacrolimus and pimecrolimus, to treat the skin lesions and prevent scarring. These topical agents can also be used in conjunction with systemic therapy.

Supportive measures include wound care, such as the use of dressings and ointments, to prevent infection and promote healing. Good oral hygiene is also important to prevent oral infections and maintain good oral health.

In some cases, surgery may be required to repair scarring or to remove damaged tissue. This may be necessary in severe cases that do not respond to other treatments.

Overall, the treatment of BPCP requires a multidisciplinary approach and individualized treatment based on the severity of the disease and the patient’s response to therapy. Close monitoring and regular follow-up are also important to ensure the best possible outcomes.

  1. https://www.ncbi.nlm.nih.gov/books/NBK11733/
  2. https://www.ncbi.nlm.nih.gov/books/NBK208/
  3. https://www.ncbi.nlm.nih.gov/books/NBK212/
  4. https://www.ncbi.nlm.nih.gov/books/NBK92761/
  5. https://www.ncbi.nlm.nih.gov/books/NBK11733/
  6. https://www.nccih.nih.gov/health/skin-conditions-at-a-glance
  7. https://www.aad.org/public/diseases/a-z
  8. https://medlineplus.gov/skinconditions.html
  9. https://www.aad.org/about/burden-of-skin-disease
  10. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  11. https://www.cdc.gov/niosh/topics/skin/default.html
  12. https://www.skincancer.org/
  13. https://www.jaad.org/
  14. https://www.psoriasis.org/about-psoriasis/
  15. https://books.google.com/books?
  16. https://www.niams.nih.gov/health-topics/skin-diseases
  17. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  18. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  19. https://dermnetnz.org/topics
  20. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  21. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  22. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  23. https://www.nibib.nih.gov/
  24. https://rxharun.com/rxharun/rxharun/article-types/skin-care-beauty/skin-diseases-types-symptoms-treatment/
  25. https://www.nei.nih.gov/
  26. https://en.wikipedia.org/wiki/List_of_skin_conditions
  27. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  28. https://en.wikipedia.org/wiki/Skin_condition
  29. https://oxfordtreatment.com/
  30. https://www.nidcd.nih.gov/health/
  31. https://consumer.ftc.gov/articles/w
  32. https://www.nccih.nih.gov/health
  33. https://catalog.ninds.nih.gov/
  34. https://www.aarda.org/diseaselist/
  35. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  36. https://www.nibib.nih.gov/
  37. https://www.nia.nih.gov/health/topics
  38. https://www.nichd.nih.gov/
  39. https://www.nimh.nih.gov/health/topics
  40. https://www.nichd.nih.gov/
  41. https://www.niehs.nih.gov
  42. https://www.nimhd.nih.gov/
  43. https://www.nhlbi.nih.gov/health-topics
  44. https://obssr.od.nih.gov/
  45. https://www.nichd.nih.gov/health/topics
  46. https://rarediseases.info.nih.gov/diseases
  47. https://beta.rarediseases.info.nih.gov/diseases
  48. https://orwh.od.nih.gov/

References