Pruritus and Pemphigoid in Nursing Home Patients

M.F. Jonkman125 enrolled

Overview

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.

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.

Study Type

OBSERVATIONAL

Enrollment

125

Conditions

Pemphigoid Pruritus

Interventions

Blood sampleOTHER

One extra blood sample of 10 ml will be taken during a routine venapunction for immunoserology testing.

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

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

Locations (1)

University Medical Center Groningen

Groningen, Netherlands

Outcomes

Primary Outcomes

Presence of pruritus

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.

Time frame: Day 1

Detection of circulating pemphigoid specific IgG autoantibodies by indirect immunofluorescence on 1M salt-split human skin substrate

IgG autoantibodies with epidermal side staining of artificial split; positive/negative, staining intensity IgG 1+,2+,3+

Time frame: Day 1

Detection of circulating pemphigoid specific IgG autoantibodies by indirect immunofluorescence microscopy on monkey esophagus substrate

Anti-basement membrane zone IgG autoantibodies; positive/negative, staining intensity IgG 1+,2+,3+

Time frame: Day 1

Concentration of anti-BP180 NC16A IgG autoantibodies by ELISA

Anti-BP180 NC16A IgG index; U/mL, cut-off value 9 U/mL

Time frame: Day 1

Concentration of anti-BP230 IgG autoantibodies by ELISA

Anti-BP230 IgG index; U/mL, cut-off value 9 U/mL

Time frame: Day 1

Detection of circulating pemphigoid specific IgG autoantibodies by immunoblot of keratinocyte extract

Presence/absence of circulating IgG autoantibodies against BP180 (180kDa) or BP230 (230kDa)

Time frame: Day 1

Secondary Outcomes

Age

For all subjects

Time frame: Day 1

Data from ClinicalTrials.gov

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