COVID-19 Outcomes in Patients with Autoimmune Bullous Dermatoses: A Comparative Study of Pemphigus Vulgaris and Bullous Pemphigoid

COVID-19 Outcomes in Patients with Autoimmune Bullous Dermatoses: A Comparative Study of Pemphigus Vulgaris and Bullous Pemphigoid | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article COVID-19 Outcomes in Patients with Autoimmune Bullous Dermatoses: A Comparative Study of Pemphigus Vulgaris and Bullous Pemphigoid Maryam Sadat Sadati, Mohsen Alizadeh, Fardin Karbakhsh Ravari, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5099446/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Autoimmune bullous dermatoses (AIBD), such as pemphigus vulgaris and bullous pemphigoid, are characterized by blister formation due to autoantibodies against skin structures. The COVID-19 pandemic has posed significant challenges in managing AIBD, as these patients may have an elevated risk of severe complications from the virus. Objective: This study aimed to investigate the prevalence and outcomes of COVID-19 in patients with AIBD, specifically comparing the clinical impact of the virus on pemphigus vulgaris and bullous pemphigoid patients. Methods: We conducted a retrospective cross-sectional study of 224 biopsy-confirmed AIBD patients referred to Shahid Faqihi Hospital in Shiraz from September 2021 to May 2023. Patient demographics, COVID-19 infection status, hospitalization, ICU admission, and mortality rates were recorded. Statistical analysis was performed using Fisher's Exact Test with a significance level of p < 0.05. Results: Of the 224 patients, 63.4% had pemphigus vulgaris, and 36.6% had bullous pemphigoid. COVID-19 infection rates were 47.2% for pemphigus vulgaris and 53.6% for bullous pemphigoid. The mortality rate was higher in pemphigus vulgaris (8.9%) compared to bullous pemphigoid (2.2%). ICU admissions were 5.9% for pemphigus vulgaris, while none were reported in the bullous pemphigoid group. Bullous pemphigoid patients were significantly less likely to experience severe COVID-19 complications (p < 0.05). Conclusion: Patients with bullous pemphigoid appear to have a lower risk of severe COVID-19 outcomes compared to those with pemphigus vulgaris. These findings highlight the need for tailored management strategies for AIBD patients during the pandemic and suggest a possible protective factor in bullous pemphigoid patients against severe COVID-19 complications. COVID-19 Pemphigus Vulgaris Bullous Pemphigoid Introduction In March 2020, the outbreak of a novel coronavirus disease known as COVID-19 caused by the SARS-CoV-2 virus was officially declared a global pandemic. This ongoing health crisis affects people worldwide, with effects ranging from subclinical to severe illness and even death 1 , 2 . Autoimmune bullous dermatoses (AIBD) are a group of skin disorders characterized by blisters and vesicles. These diseases are caused by the production of autoantibodies against specific skin structures, leading to blister formation 3 . AIBD, such as bullous pemphigoid and pemphigus vulgaris, are more common in older individuals. Bullous pemphigoid typically affects people in their 80s, while pemphigus occurs before age 65 4–6 . The risk of severe COVID-19 is elevated in people with autoimmune conditions compared to the general population, as shown by numerous studies 7 – 9 . The COVID-19 pandemic has presented significant challenges for healthcare providers managing autoimmune bullous diseases such as pemphigus and pemphigoid 10 – 12 . The limited research on COVID-19 outcomes in AIBD patients has yielded contradictory findings 13 – 16 . We aimed to better understand the effect of COVID-19 on these at-risk patients by assessing a group of patients with AIBD. Methods This study is a retrospective cross-sectional study. This study's statistical population included biopsy-confirmed AIBD patients referred to Shahid Faqihi Hospital in Shiraz from September 1, 2021, to May 1, 2023. Inclusion criteria were Patients with skin blister lesions, Confirmation of autoimmune skin bullous disease by skin biopsy, and not having any other underlying disease. Exclusion criteria were Reluctance to cooperate, incomplete information, and Patients who reported a history of coronavirus infection but did not have a documented PCR test. The study concept was explained to the patients, and those who wanted to participate were included. The data was obtained from the patient's medical records and through follow-up phone calls. The study protocol underwent review and approval by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1402.544). The number of participants was estimated to be 250 patients using Power G software with 5% type 1 error, 80% power, and 5% accuracy. 26 patients were excluded from the study due to incomplete information or unwillingness to participate. 224 patients were included in the study. The demographics of the patients were recorded. In cases of coronavirus infection, hospitalization and ICU admission due to coronavirus or worsening of skin complications and death of the patient were also recorded. Coronavirus infection patients were enrolled based on a positive PCR test. Number and percentage were used for qualitative variables. The Fisher's Exact Test was used for statistical analysis. The significance level for the p-value was set at 0.05. The data analysis was conducted using SPSS version 24 software. Results This study examined 224 patients with AIBD. 142 patients (63.4%) had pemphigus vulgaris, and 82 (36.6%) had bullous pemphigoid. 71.9% of the total studied population were also women. Women in both groups had pemphigus vulgaris (66.9%) and bullous pemphigoid (80.5%) in the majority. Among those with bolus pemphigoid, 44 people (53.6%) had a history of infection with COVID-19 confirmed by a positive reverse transcriptase PCR (RT-PCR) in the last two years. 59 people (71.9%) had also received a vaccine before contracting COVID-19. In the group of pemphigus vulgaris, 67 people (47.2%) had a history of infection with COVID-19 confirmed by a positive RT-PCR in the last two years. 96 people (67.6%) had also received a vaccine before contracting Covid-19. (Table 1 ) Table 1 Demographic features of 224 autoimmune bullous dermatoses patients Among bolus pemphigoid patients with a history of coronavirus infection, 6 (13.6%) were admitted to the hospital, and 4 (9%) had experienced an increase in the severity of bullous disease during the coronavirus infection. The mortality rate was 2.2% (1 person), and none of the patients were admitted to the intensive care unit (ICU) during the coronavirus infection. While in the group of patients with pemphigus vulgaris with a history of coronavirus infection, 12 people (17.9%) were admitted to the hospital, 4 people (5.9%) were admitted to the ICU, and 9 people (13.4%) had an increase in the severity of bullous disease in They had experienced the coronavirus. The mortality rate was 8.9% (6 people) in this group. (Table 2 ) variable Pemphigus vulgaris Number (%) Bullous pemphigoid Number (%) Total number (%) sex male 47 (33.1) 16 (19.5) 63 (28.1) female 95 (66.9) 66 (80.5) 161 (71.9) History of vaccination positive 96 (67.6) 59 (71.9) 155 (69.1) negative 46 (32.4) 23 (28.1) 69 (30.9) History of corona infection in the last two years positive 67 (47.2) 44 (53.6) 111 (49.5) negative 75 (52.8) 38 (46.4) 113 (50.5) Table 2 The effects of Corona on autoimmune bullous dermatoses patients with history of Coronavirus infection The data in Table 3 indicates no significant relationship exists between coronavirus infection in blister diseases and hospitalization, ICU admission, mortality, or worsening of blistering disease severity (P > 0.05). However, there is a significant association between bullous pemphigoid disease and reduced complications, such as hospitalization, ICU admission, worsening skin symptoms, and death in coronavirus infection (P < 0.05). variable Pemphigus vulgaris Number (%) Bullous pemphigoid Number (%) Hospital admission 12 (17.9) 6 (13.6) ICU admission 4 (5.9) 0 (0) mortality 6 (8.9) 1 (2.2) Increased severity of bullous dermatoses 9 (13.4) 4 (9.0) none 36 (53.9) 33 (75.2) Table 3 Fisher's Exact Test result between two group of bullous dermatoses and effect of corona Variable Odds Ratio p-value Hospital admission 1.3818 0.6085 ICU admission infinity 0.1506 Mortality 4.2295 0.2406 Increased severity of bullous dermatoses 1.5517 0.5597 None 0.3871 0.0285 Discussion This study aimed to investigate the prevalence and outcomes of COVID-19 in patients with autoimmune bullous diseases (AIBD), specifically bullous pemphigoid and pemphigus vulgaris. Our findings revealed that a significant proportion of patients with these conditions had a history of COVID-19, with 53.6% of bullous pemphigoid patients and 47.2% of pemphigus vulgaris patients reporting a previous infection. These numbers are higher than the overall prevalence of COVID-19 in patients with AIBD reported in a previous study in 2023, which was 12.2% 17 . In a meta-analysis, it was observed that patients with autoimmune diseases such as AIBD have a higher risk of acquiring COVID-19, mainly when glucocorticoids are used for treatment. The results of this meta-analysis strengthen our findings due to the higher incidence of COVID-19 in the AIBD population compared to the general population 18 . The prevalence of COVID-19 in our study population can be compared to the general population in Iran. The estimated prevalence of COVID-19 in Iran in 2020 was 14.2%, with 11,958,346 confirmed cases 19 . It is important to note that the percentage of patients in our population who received at least one dose of the COVID-19 vaccine (69%) was similar to that of the general population in Iran who had received at least one dose (70–88%). This suggests that our study population is representative of the general population regarding vaccination status 20 , 21 . • Pemphigus Vulgaris In terms of the outcomes of COVID-19 in patients with pemphigus vulgaris, our study found a mortality rate of 8.9%, which is consistent with the findings of a previous study by Kridin et al. (2021). However, Özgen et al. (2022) reported a lower mortality rate of 1.9% 16,22 . These differences in mortality rates can be attributed to variations in the strains of COVID-19 and differences in the study populations. Similarly, a study conducted in India reported a higher mortality rate of 18% in pemphigus vulgaris patients with COVID-19, which may be due to differences in the healthcare system and patient characteristics 17 . This difference can be explained by the difference in the common strains of Covid-19 in the two countries and the difference in the study population. In terms of hospitalization and ICU admission, our study found lower rates than previous estimates. While previous studies reported hospitalization rates of 50% and ICU admission rates of 0% in pemphigus vulgaris patients with COVID-19, our study found rates of 17.9% and 5.9%, respectively. These differences could be attributed to variations in the severity of COVID-19 cases, differences in healthcare systems, and variations in patient characteristics 16 , 23 . In the current study, 13.4% of patients experienced the severity of pemphigus vulgaris symptoms during COVID-19 infection. This percentage closely aligns with the previously estimated 16.9% 23 . • Bullous pemphigoid For patients with bullous pemphigoid, our study found a mortality rate of 2.2% and a hospitalization rate of 13.6%, which were significantly lower than the rates reported in the study by Kridin et al. (2021) (with 30% mortality and 50% hospitalization). It's worth noting that ICU hospitalization prevalence was 0% in both studies 16 . However, these rates were similar to those reported in Italy, with a mortality rate of 6.5% and a hospitalization rate of 4.8% 24 . Again, differences in the study populations and variations in the strains of COVID-19 could account for these differences in outcomes. The current study found that 9% of patients with bullous pemphigoid experienced increased disease severity after contracting Covid-19. However, the exact percentage of bullous pemphigoid patients whose symptoms worsened due to COVID-19 infection is not directly stated in the available literature. Nevertheless, a previous study has reported cases of new-onset or worsening bullous pemphigoid following COVID-19 vaccination, indicating a possible link between COVID-19 and the development of this autoimmune bullous disease 25 , 26 . There is no significant relationship between coronavirus infection and bullous diseases with regards to The effects of Corona on AIBD patients, such as hospitalization, ICU admission, mortality, or worsening of blistering disease severity (P > 0.05). Other studies have found a higher frequency of coronavirus complications among individuals with various systemic autoimmune diseases and inflammatory bowel disease (IBD) 27 , 28 . Interestingly, our study found that patients with bullous pemphigoid were less likely to experience severe complications from COVID-19 compared to patients with pemphigus vulgaris. There was a significant association between bullous pemphigoid and reduced complications such as hospitalization, ICU admission, worsening skin symptoms, and death in COVID-19 infection (P < 0.05). This suggests that patients with bullous pemphigoid may have some level of protection against severe COVID-19 complications, although the exact mechanisms behind this association are not yet understood. In various studies, it has been observed that the severity of COVID-19 in patients with AIBD is influenced by various factors such as corticosteroid use, smoking, and the duration of the disease 29 – 31 . However, a study found no significant relationship between the use of systemic corticosteroids and immunosuppressive agents in AIBD patients and the severity and incidence of COVID-19 16 . A study has found that patients with pemphigus and pemphigoid who also have COVID-19 are not at a higher risk for severe COVID-19 complications compared to those with COVID-19 but without pemphigus or pemphigoid. Additionally, the duration of use of systemic immunosuppressants does not increase the risk of complications in patients with pemphigus and pemphigoid 32 . However, more research is needed to fully understand the relationship between AIBD diseases, medication use, and COVID-19 outcomes. Conclusion Our study provides valuable insights into the prevalence and outcomes of COVID-19 in patients with AIBD, specifically bullous pemphigoid and pemphigus vulgaris. Our findings suggest that patients with bullous pemphigoid may have a lower risk of severe COVID-19 complications than patients with pemphigus vulgaris. However, further research is needed to confirm these findings and explore these associations' underlying mechanisms. These findings can contribute to developing targeted interventions and treatment strategies for AIBD patients during the COVID-19 pandemic. Declarations Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Mohsen Alizadeh was primarily responsible for data collection and statistical analyses. His meticulous handling of the data ensured the robustness and accuracy of the results. Ali Rafiei and Fardin Karbakhsh Ravari contributed significantly to the manuscript writing and final editing, integrating comprehensive literature insights and refining the discussion to provide clarity and depth. Maryam Sadat Sadati conceptualized the study, led its design, and provided oversight throughout the research process, ensuring that the study adhered to the highest scientific and ethical standards. She also played a pivotal role in guiding the research direction and finalizing key decisions.All authors were involved in the interpretation of the data, critically reviewed the manuscript for intellectual content, and approved the final version for submission. Their collective efforts have culminated in this manuscript, which they believe will advance the understanding of COVID-19 outcomes in autoimmune bullous dermatoses. Acknowledgements Thanks to patients and Shiraz University of Medical Sciences for providing the information. References Cucinotta D, Vanelli M (2020) WHO Declares COVID-19 a Pandemic. Acta Biomed Mar 19(1):157–160. 10.23750/abm.v91i1.9397 Daneshpazhooh M, Mahmoudi H (2021) COVID-19: The experience from Iran. Clin Dermatol Jan-Feb 39(1):23–32. 10.1016/j.clindermatol.2020.12.009 Sadik CD, Schmidt E, Zillikens D, Hashimoto T (2020) Recent progresses and perspectives in autoimmune bullous diseases. J Allergy Clin Immunol 145 4:1145–1147 Pyrek A, Eliszewska L, Rutecka N, Owczarczyk-Saczonek A, Placek W (2022) Autoimmunologiczne choroby pęcherzowe skóry — analiza retrospektywna. Forum Dermatologicum Patsatsi A, Lamprou F, Kokolios M et al (2017) Spectrum of Autoimmune Bullous Diseases in Northern Greece. A 4-year Retrospective Study and Review of the Literature. Acta dermatovenerologica Croatica: ADC 25 3:195–201 Merino KM, Jazwinski SM, Rout N (2021) Th17-type immunity and inflammation of aging. Aging (Albany NY) May 28(10):13378–13379. 10.18632/aging.203119 Solé G, Mathis S, Friedman D et al (2021) Impact of coronavirus disease 2019 in a French cohort of myasthenia gravis. Neurology 96(16):e2109–e2120 Arleo T, Tong D, Shabto J, O'Keefe G, Khosroshahi A (2021) Clinical course and outcomes of COVID-19 in rheumatic disease patients: a case cohort study with a diverse population. 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J Am Acad Dermatol Apr 84(4):1098–1100. 10.1016/j.jaad.2020.12.043 Sinagra JL, Vedovelli C, Binazzi R et al (2021) Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab. Front Immunol 12:665522. 10.3389/fimmu.2021.665522 Hwang E, Tomayko MM (2021) COVID-19 outcomes in patients with autoimmune blistering disease. Br J Dermatol 185:1048–1050 Kridin K, Schonmann Y, Weinstein O, Schmidt E, Ludwig RJ, Cohen AD (2021) The risk of COVID-19 in patients with bullous pemphigoid and pemphigus: A population-based cohort study. J Am Acad Dermatol Jul 85(1):79–87. 10.1016/j.jaad.2021.02.087 De D, Ashraf R, Mehta H, Handa S, Mahajan R (2023) Outcome of COVID-19 in patients with autoimmune bullous diseases. Indian J Dermatol Venereol Leprol Nov-Dec 89(6):862–866. 10.25259/ijdvl_551_2022 Akiyama S, Hamdeh S, Micic D, Sakuraba A (2020) Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis Khalagi K, Gharibzadeh S, Khalili D et al (2021) Prevalence of COVID-19 in Iran: results of the first survey of the Iranian COVID-19 Serological Surveillance programme. Clin Microbiol Infect 27:1666–1671 Omidvar S, Firouzbakht M (2022) Acceptance of COVID-19 vaccine and determinant factors in the Iranian population: a web-based study. BMC Health Serv Res. ;22 Tavousi M, Rezaei F, Sadighi J et al (2023) Correlates of COVID-19 vaccination in Iranian adults. Payesh (Health Monitor) J Özgen Z, Aksoy H, Akın Çakıcı Ö et al (2022) COVID-19 severity and SARS-Cov-2 vaccine safety in pemphigus patients. Dermatol Ther May 35(5):e15417. 10.1111/dth.15417 Aryanian Z, Balighi K, Sajad B et al (2023) COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID-19? J Cosmet Dermatol Nov 22(11):2880–2888. 10.1111/jocd.15958 Drenovska K, Vassileva S, Tanev I, Joly P (2021) Impact of COVID-19 on autoimmune blistering diseases. Clin Dermatol May-Jun 39(3):359–368. 10.1016/j.clindermatol.2021.01.007 Birabaharan M, Kaelber DC, Orme CM, Paravar T, Karris MY (2022) Evaluating risk of bullous pemphigoid after mRNA COVID-19 vaccination. Br J Dermatol Aug 187(2):271–273. 10.1111/bjd.21240 Olson N, Eckhardt D, Delano A (2021) New-Onset Bullous Pemphigoid in a COVID-19 Patient. Case Rep Dermatol Med 2021:5575111. 10.1155/2021/5575111 Ansarin K, Taghizadieh A, Safiri S et al (2022) COVID-19 outcomes in patients with systemic autoimmune diseases treated with immunomodulatory drugs. Ann Rheum Dis Oct 81(10):e190. 10.1136/annrheumdis-2020-218737 Macaluso FS, Orlando A (2020) COVID-19 in patients with inflammatory bowel disease: A systematic review of clinical data. Dig Liver Dis Nov 52(11):1222–1227. 10.1016/j.dld.2020.09.002 Drenovska K, Vassileva S, Tanev IV, Joly P (2021) Impact of COVID-19 on autoimmune blistering diseases. Clin Dermatol 39:359–368 Pira A, Sinagra JLM, Moro F, Mariotti F, Di Zenzo G (2023) Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine. Front Med. ;10 Kasperkiewicz M, Woodley DT (2023) COVID-19 and autoimmune bullous diseases: Lessons learned. Autoimmun rev 22:103286–103286 Pakhchanian H, Raiker R, Wang J, Phan K (2021) LB761 Clinical outcomes in Pemphigoid and Pemphigus patients with COVID-19. J Invest Dermatol 141:B13–B13 Additional Declarations No competing interests reported. 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This ongoing health crisis affects people worldwide, with effects ranging from subclinical to severe illness and even death \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAutoimmune bullous dermatoses (AIBD) are a group of skin disorders characterized by blisters and vesicles. These diseases are caused by the production of autoantibodies against specific skin structures, leading to blister formation \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. AIBD, such as bullous pemphigoid and pemphigus vulgaris, are more common in older individuals. Bullous pemphigoid typically affects people in their 80s, while pemphigus occurs before age 65 \u003csup\u003e4\u0026ndash;6\u003c/sup\u003e. The risk of severe COVID-19 is elevated in people with autoimmune conditions compared to the general population, as shown by numerous studies \u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The COVID-19 pandemic has presented significant challenges for healthcare providers managing autoimmune bullous diseases such as pemphigus and pemphigoid \u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe limited research on COVID-19 outcomes in AIBD patients has yielded contradictory findings \u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. We aimed to better understand the effect of COVID-19 on these at-risk patients by assessing a group of patients with AIBD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a retrospective cross-sectional study. This study's statistical population included biopsy-confirmed AIBD patients referred to Shahid Faqihi Hospital in Shiraz from September 1, 2021, to May 1, 2023. Inclusion criteria were Patients with skin blister lesions, Confirmation of autoimmune skin bullous disease by skin biopsy, and not having any other underlying disease. Exclusion criteria were Reluctance to cooperate, incomplete information, and Patients who reported a history of coronavirus infection but did not have a documented PCR test. The study concept was explained to the patients, and those who wanted to participate were included. The data was obtained from the patient's medical records and through follow-up phone calls. The study protocol underwent review and approval by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1402.544).\u003c/p\u003e \u003cp\u003eThe number of participants was estimated to be 250 patients using Power G software with 5% type 1 error, 80% power, and 5% accuracy. 26 patients were excluded from the study due to incomplete information or unwillingness to participate. 224 patients were included in the study. The demographics of the patients were recorded. In cases of coronavirus infection, hospitalization and ICU admission due to coronavirus or worsening of skin complications and death of the patient were also recorded. Coronavirus infection patients were enrolled based on a positive PCR test.\u003c/p\u003e \u003cp\u003eNumber and percentage were used for qualitative variables. The Fisher's Exact Test was used for statistical analysis. The significance level for the p-value was set at 0.05. The data analysis was conducted using SPSS version 24 software.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study examined 224 patients with AIBD. 142 patients (63.4%) had pemphigus vulgaris, and 82 (36.6%) had bullous pemphigoid. 71.9% of the total studied population were also women. Women in both groups had pemphigus vulgaris (66.9%) and bullous pemphigoid (80.5%) in the majority. Among those with bolus pemphigoid, 44 people (53.6%) had a history of infection with COVID-19 confirmed by a positive reverse transcriptase PCR (RT-PCR) in the last two years. 59 people (71.9%) had also received a vaccine before contracting COVID-19. In the group of pemphigus vulgaris, 67 people (47.2%) had a history of infection with COVID-19 confirmed by a positive RT-PCR in the last two years. 96 people (67.6%) had also received a vaccine before contracting Covid-19. (Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic features of 224 autoimmune bullous dermatoses patients Among bolus pemphigoid patients with a history of coronavirus infection, 6 (13.6%) were admitted to the hospital, and 4 (9%) had experienced an increase in the severity of bullous disease during the coronavirus infection. The mortality rate was 2.2% (1 person), and none of the patients were admitted to the intensive care unit (ICU) during the coronavirus infection. While in the group of patients with pemphigus vulgaris with a history of coronavirus infection, 12 people (17.9%) were admitted to the hospital, 4 people (5.9%) were admitted to the ICU, and 9 people (13.4%) had an increase in the severity of bullous disease in They had experienced the coronavirus. The mortality rate was 8.9% (6 people) in this group. (Table\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePemphigus vulgaris\u003c/p\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBullous pemphigoid\u003c/p\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal number (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003emale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63 (28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003efemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66 (80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e161 (71.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003epositive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e155 (69.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enegative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69 (30.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of corona infection in the last two years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003epositive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e111 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enegative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e113 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe effects of Corona on autoimmune bullous dermatoses patients with history of Coronavirus infection The data in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicates no significant relationship exists between coronavirus infection in blister diseases and hospitalization, ICU admission, mortality, or worsening of blistering disease severity (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, there is a significant association between bullous pemphigoid disease and reduced complications, such as hospitalization, ICU admission, worsening skin symptoms, and death in coronavirus infection (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePemphigus vulgaris\u003c/p\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBullous pemphigoid\u003c/p\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased severity of bullous dermatoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (75.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFisher's Exact Test result between two group of bullous dermatoses and effect of corona\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003einfinity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.2406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased severity of bullous dermatoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the prevalence and outcomes of COVID-19 in patients with autoimmune bullous diseases (AIBD), specifically bullous pemphigoid and pemphigus vulgaris. Our findings revealed that a significant proportion of patients with these conditions had a history of COVID-19, with 53.6% of bullous pemphigoid patients and 47.2% of pemphigus vulgaris patients reporting a previous infection. These numbers are higher than the overall prevalence of COVID-19 in patients with AIBD reported in a previous study in 2023, which was 12.2% \u003csup\u003e17\u003c/sup\u003e. In a meta-analysis, it was observed that patients with autoimmune diseases such as AIBD have a higher risk of acquiring COVID-19, mainly when glucocorticoids are used for treatment. The results of this meta-analysis strengthen our findings due to the higher incidence of COVID-19 in the AIBD population compared to the general population \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe prevalence of COVID-19 in our study population can be compared to the general population in Iran. The estimated prevalence of COVID-19 in Iran in 2020 was 14.2%, with 11,958,346 confirmed cases \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. It is important to note that the percentage of patients in our population who received at least one dose of the COVID-19 vaccine (69%) was similar to that of the general population in Iran who had received at least one dose (70\u0026ndash;88%). This suggests that our study population is representative of the general population regarding vaccination status \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Pemphigus Vulgaris\u003c/h2\u003e \u003cp\u003eIn terms of the outcomes of COVID-19 in patients with pemphigus vulgaris, our study found a mortality rate of 8.9%, which is consistent with the findings of a previous study by Kridin et al. (2021). However, \u0026Ouml;zgen et al. (2022) reported a lower mortality rate of 1.9% \u003csup\u003e16,22\u003c/sup\u003e. These differences in mortality rates can be attributed to variations in the strains of COVID-19 and differences in the study populations. Similarly, a study conducted in India reported a higher mortality rate of 18% in pemphigus vulgaris patients with COVID-19, which may be due to differences in the healthcare system and patient characteristics \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This difference can be explained by the difference in the common strains of Covid-19 in the two countries and the difference in the study population. In terms of hospitalization and ICU admission, our study found lower rates than previous estimates. While previous studies reported hospitalization rates of 50% and ICU admission rates of 0% in pemphigus vulgaris patients with COVID-19, our study found rates of 17.9% and 5.9%, respectively. These differences could be attributed to variations in the severity of COVID-19 cases, differences in healthcare systems, and variations in patient characteristics \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In the current study, 13.4% of patients experienced the severity of pemphigus vulgaris symptoms during COVID-19 infection. This percentage closely aligns with the previously estimated 16.9% \u003csup\u003e23\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; Bullous pemphigoid\u003c/h2\u003e \u003cp\u003eFor patients with bullous pemphigoid, our study found a mortality rate of 2.2% and a hospitalization rate of 13.6%, which were significantly lower than the rates reported in the study by Kridin et al. (2021) (with 30% mortality and 50% hospitalization). It's worth noting that ICU hospitalization prevalence was 0% in both studies \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. However, these rates were similar to those reported in Italy, with a mortality rate of 6.5% and a hospitalization rate of 4.8% \u003csup\u003e24\u003c/sup\u003e. Again, differences in the study populations and variations in the strains of COVID-19 could account for these differences in outcomes. The current study found that 9% of patients with bullous pemphigoid experienced increased disease severity after contracting Covid-19. However, the exact percentage of bullous pemphigoid patients whose symptoms worsened due to COVID-19 infection is not directly stated in the available literature. Nevertheless, a previous study has reported cases of new-onset or worsening bullous pemphigoid following COVID-19 vaccination, indicating a possible link between COVID-19 and the development of this autoimmune bullous disease \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is no significant relationship between coronavirus infection and bullous diseases with regards to The effects of Corona on AIBD patients, such as hospitalization, ICU admission, mortality, or worsening of blistering disease severity (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Other studies have found a higher frequency of coronavirus complications among individuals with various systemic autoimmune diseases and inflammatory bowel disease (IBD) \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Interestingly, our study found that patients with bullous pemphigoid were less likely to experience severe complications from COVID-19 compared to patients with pemphigus vulgaris. There was a significant association between bullous pemphigoid and reduced complications such as hospitalization, ICU admission, worsening skin symptoms, and death in COVID-19 infection (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests that patients with bullous pemphigoid may have some level of protection against severe COVID-19 complications, although the exact mechanisms behind this association are not yet understood. In various studies, it has been observed that the severity of COVID-19 in patients with AIBD is influenced by various factors such as corticosteroid use, smoking, and the duration of the disease \u003csup\u003e\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. However, a study found no significant relationship between the use of systemic corticosteroids and immunosuppressive agents in AIBD patients and the severity and incidence of COVID-19 \u003csup\u003e16\u003c/sup\u003e. A study has found that patients with pemphigus and pemphigoid who also have COVID-19 are not at a higher risk for severe COVID-19 complications compared to those with COVID-19 but without pemphigus or pemphigoid. Additionally, the duration of use of systemic immunosuppressants does not increase the risk of complications in patients with pemphigus and pemphigoid \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. However, more research is needed to fully understand the relationship between AIBD diseases, medication use, and COVID-19 outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study provides valuable insights into the prevalence and outcomes of COVID-19 in patients with AIBD, specifically bullous pemphigoid and pemphigus vulgaris. Our findings suggest that patients with bullous pemphigoid may have a lower risk of severe COVID-19 complications than patients with pemphigus vulgaris. However, further research is needed to confirm these findings and explore these associations' underlying mechanisms. These findings can contribute to developing targeted interventions and treatment strategies for AIBD patients during the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMohsen Alizadeh was primarily responsible for data collection and statistical analyses. His meticulous handling of the data ensured the robustness and accuracy of the results. Ali Rafiei and Fardin Karbakhsh Ravari contributed significantly to the manuscript writing and final editing, integrating comprehensive literature insights and refining the discussion to provide clarity and depth. Maryam Sadat Sadati conceptualized the study, led its design, and provided oversight throughout the research process, ensuring that the study adhered to the highest scientific and ethical standards. She also played a pivotal role in guiding the research direction and finalizing key decisions.All authors were involved in the interpretation of the data, critically reviewed the manuscript for intellectual content, and approved the final version for submission. Their collective efforts have culminated in this manuscript, which they believe will advance the understanding of COVID-19 outcomes in autoimmune bullous dermatoses.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThanks to patients and Shiraz University of Medical Sciences for providing the information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCucinotta D, Vanelli M (2020) WHO Declares COVID-19 a Pandemic. 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Autoimmun rev 22:103286\u0026ndash;103286\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePakhchanian H, Raiker R, Wang J, Phan K (2021) LB761 Clinical outcomes in Pemphigoid and Pemphigus patients with COVID-19. J Invest Dermatol 141:B13\u0026ndash;B13\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Pemphigus Vulgaris, Bullous Pemphigoid","lastPublishedDoi":"10.21203/rs.3.rs-5099446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5099446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eAutoimmune bullous dermatoses (AIBD), such as pemphigus vulgaris and bullous pemphigoid, are characterized by blister formation due to autoantibodies against skin structures. The COVID-19 pandemic has posed significant challenges in managing AIBD, as these patients may have an elevated risk of severe complications from the virus.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the prevalence and outcomes of COVID-19 in patients with AIBD, specifically comparing the clinical impact of the virus on pemphigus vulgaris and bullous pemphigoid patients.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cross-sectional study of 224 biopsy-confirmed AIBD patients referred to Shahid Faqihi Hospital in Shiraz from September 2021 to May 2023. Patient demographics, COVID-19 infection status, hospitalization, ICU admission, and mortality rates were recorded. Statistical analysis was performed using Fisher's Exact Test with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOf the 224 patients, 63.4% had pemphigus vulgaris, and 36.6% had bullous pemphigoid. COVID-19 infection rates were 47.2% for pemphigus vulgaris and 53.6% for bullous pemphigoid. The mortality rate was higher in pemphigus vulgaris (8.9%) compared to bullous pemphigoid (2.2%). ICU admissions were 5.9% for pemphigus vulgaris, while none were reported in the bullous pemphigoid group. Bullous pemphigoid patients were significantly less likely to experience severe COVID-19 complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003ePatients with bullous pemphigoid appear to have a lower risk of severe COVID-19 outcomes compared to those with pemphigus vulgaris. These findings highlight the need for tailored management strategies for AIBD patients during the pandemic and suggest a possible protective factor in bullous pemphigoid patients against severe COVID-19 complications.\u003c/p\u003e","manuscriptTitle":"COVID-19 Outcomes in Patients with Autoimmune Bullous Dermatoses: A Comparative Study of Pemphigus Vulgaris and Bullous Pemphigoid","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-18 13:42:53","doi":"10.21203/rs.3.rs-5099446/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1c40acb4-c453-4b12-aa40-eb27b696159c","owner":[],"postedDate":"November 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-22T05:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-18 13:42:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5099446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5099446","identity":"rs-5099446","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}