Bullous pemphigoid (BP), one of the most common autoimmune blistering disorders, usually arises during late adulthood. Several recent publications have reported estimates of the prevalence and incidence of BP within different populations.1,2 Although most patients with BP present with typical clinical findings, the diagnosis must be confirmed by routine histologic analysis and direct immunofluorescence of lesional and perilesional skin, respectively. Indirect immunofluorescence, with the use of sodium chloride–split human skin as the substrate, further distinguishes BP from epidermolysis bullosa acquisita, which at times may be otherwise indistinguishable clinically, histologically, and immunohistochemically.3 Over the past several years, enzyme-linked immunosorbent assay (ELISA) tests with reported high sensitivity and specificity have been developed and used for the detection of both pemphigoid and pemphigus autoantibodies, and many clinicians now include these as part of the routine evaluation of their patients.
Fine J. Prevalence of Autoantibodies to Bullous Pemphigoid Antigens Within the Normal Population. Arch Dermatol. 2010;146(1):74-75. doi:10.1001/archdermatol.2009.324