Pemphigoid, Pruritus
Conditions
Keywords
Pemphigoid, Bullous pemphigoid, Pruritus, Senile pruritus, Neuropsychiatric symptoms
Brief summary
The primary objective of this observational study is to describe the prevalence of pruritus and pemphigoid in nursing home patients. Secondary outcomes are the relationships of demographic factors and medical risk factors with pemphigoid, including dementia and neuropsychiatric symptoms, medication use and Karnofsky score.
Detailed description
Pruritus or itch is the most common skin symptom in elderly patients and is estimated to affect more than 30% of nursing home patients. Clinical and experimental evidence suggests pruritus in elderly patients may be linked to pemphigoid. Pemphigoid is the most common autoimmune skin blistering diseases and mainly affects the elderly. It is successfully treatable with systemic therapy. However, pemphigoid is often missed as a cause of pruritus in elderly patients (nonbullous cutaneous pemphigoid). Although nursing home patients and patients with dementia in particular have the highest risk for development of pemphigoid, no study has been performed in this population so far. Including serological screening for pemphigoid in the diagnostic evaluation of chronic pruritus in nursing home patients may lead to the diagnosis of pemphigoid. Furthermore, chronic itch may be an unrecognized cause of neuropsychiatric symptoms in nursing home patients with dementia.
Interventions
OTHERBlood sample
One extra blood sample of 10 ml will be taken during a routine venapunction for immunoserology testing.
Sponsors
M.F. Jonkman
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inpatient of a nursing home * Age 65 years or above * Subject or their official representatives have signed informed consent
Exclusion criteria
* Age below 65 years * Subjects who do not have signed informed consent * Receiving treatment with any systemic immunosuppressive agents * Terminally ill patients with a life expectancy of less than 4 weeks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Detection of circulating pemphigoid specific IgG autoantibodies by immunoblot of keratinocyte extract | Day 1 | Presence/absence of circulating IgG autoantibodies against BP180 (180kDa) or BP230 (230kDa) |
| Presence of pruritus | Day 1 | Presence and intensity of pruritus will be determined (hetero-)anamnestically with the Bullous Pemphigoid Disease Area Index (BPDAI) VAS score and derivative score for all subjects. |
| Detection of circulating pemphigoid specific IgG autoantibodies by indirect immunofluorescence on 1M salt-split human skin substrate | Day 1 | IgG autoantibodies with epidermal side staining of artificial split; positive/negative, staining intensity IgG 1+,2+,3+ |
| Detection of circulating pemphigoid specific IgG autoantibodies by indirect immunofluorescence microscopy on monkey esophagus substrate | Day 1 | Anti-basement membrane zone IgG autoantibodies; positive/negative, staining intensity IgG 1+,2+,3+ |
| Concentration of anti-BP180 NC16A IgG autoantibodies by ELISA | Day 1 | Anti-BP180 NC16A IgG index; U/mL, cut-off value 9 U/mL |
| Concentration of anti-BP230 IgG autoantibodies by ELISA | Day 1 | Anti-BP230 IgG index; U/mL, cut-off value 9 U/mL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Age | Day 1 | For all subjects |
| Sex | Day 1 | For all subjects |
| Comorbidities | Day 1 | Presence/absence of comorbidities dementia, cerebrovascular accident, Parkinson's disease, other neurological disease or other diseases |
| Karnofsky Performance Scale | Day 1 | 0% - 100% |
| Medication | Day 1 | Registration of medication use for all subjects |
| Neuropsychiatric symptoms | Day 1 | Neuropsychiatric Inventory - Nursing Home version in Dutch |
Countries
Netherlands
Outcome results
None listed