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Autoimmune bullous dermatoses: should we treat the patient or the antibodies? A preliminary study

Serological detection of autoantibodies via indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assays (ELISA) is usually helpful in the diagnostic process of autoimmune bullous dermatoses (AIBDs) [1]. ELISA provides objective and quantitative results, which may better reflect disease activity than those of IIF [1]. In fact, the titre of antibodies is reported to correlate with disease activity over time, especially anti-desmoglein (anti-Dsg) -1 and -3 in patients with pemphigus vulgaris (PV) and anti-BP180 in patients with bullous pemphigoid (BP). In contrast, the association between anti-BP230 titre and clinical course appears to be less evident [1, 2]. However, the association between titres of antibodies and disease activity and severity is still debated [3]. Should antibody titres guide therapeutic decisions or should they be based on clinical activity? All patients who were diagnosed with BP or PV (histologically and/or based on laboratory findings) over a 12-month period were consecutively enrolled. They were evaluated clinically and their blood was collected for serology at T0, three months later (T1) and six months later (T2). Clinical disease activity was given a score ranging 03. Patients with PV were given a score of 1 for moderate disease (Autoimmune Bullous Skin Disorder Intensity Score [ABSIS] <6.4), 2 for significant disease (6.4<ABSIS<31.5), and 3 for extensive disease (ABSIS>31.5) [4]. ABSIS was used rather than PDAI (Pemphigus Disease Area Index) because the latter has been validated as a score for PV with only 2 degrees of clinical severity [4]. Patients with BP were given a score of 1 for mild disease (Bullous Pemphigoid Disease Area Index [BPDAI] <20), 2 for moderate disease (20<BPDAI<57),