Bullous pemphigoid in a leg affected with hemiparesia: a possible relationof neurological diseases with bullous pemphigoid?

We report a typical case of bullous pemphigoid (BP) associated with a neuro logical disorder and study a possible link between neurological disorders a nd BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemipar etic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were re trospectively analyzed (average age: 79; median age: 85), Thirty of the 46 patients with BP had neurological disorders. These disorders included demen tia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, go nadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis, In a con trol group of the 46 consecutive oldest patients (older than 71; average ag e: 82,5; median age: 80) with another skin disease referred during the prev ious two-year-period to our one-day-unit only, 13 patients had a neurologic al disorder. This study demonstrates that there is a high prevalence of neu rological disorders in patients with BP (p = 0.0004), A prospective case co ntrol study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associ ated with the aging process or neurological disorders may be involved in pe mphigoid development via an autoimmune response against dystonin which shar es homology with bullous pemphigoid antigen 1. Bullous pem phigoid could be considered to be a marker of neurological disorder.