ABSTRACT
Bullous pemphigoid (BP) is the most common autoimmune bullous disease characterized by autoantibodies against hemidesmosomal components: BP180 and BP230. Although a causal association between vaccine and BP has never been proved, since mass vaccination against COVID-19 started, more than 90 vaccine-associated BP were reported. Of note, a recent study comparing very large cohorts of vaccinated and not-vaccinated individuals found no increased incidence of BP in vaccinated people, concluding that COVID-19 vaccine does not directly cause BP. To bring to an agreement among real-life clinical observations on patients with new-onset BP after COVID-19 vaccine and recent epidemiologic data, a cohort study was performed. Fifty-nine BP patients visiting our institute in 2021 were clinically and immunologically characterized. Fourteen patients (23.7%), experiencing BP onset 1-34 days after the first or second dose, were considered vaccine-associated. Vaccine-associated and non-associated patients had the same M/F ratio (1.3) and similar disease severity (mean BPDAI: 41.1 vs 38.6) and mean age (76.7 vs 79.5 years). Interestingly, BP230 reactivity was higher in vaccine-associated patients (87.5% vs 41.4%, p=0.042), while no other significant differences in autoantibodies profiles and titers were found. Noteworthy, the comparison of the monthly distribution of BP onset throughout the year before and during mass vaccination showed significant differences: in 2021, BP onsets on April-May and June-July increased (p=0.009) and declined (p=0.064) compared to 2018-2020, respectively. In conclusion, our findings suggest that COVID-19 vaccine may be considered an accelerating factor rather than an inducing one: vaccination, in genetically predisposed individuals with sub-clinical autoreactivity against BP antigens, of which high BP230 reactivity at diagnosis could represent an indicator, could slightly anticipate BP onset without increasing its incidence.Copyright © 2023
ABSTRACT
Background: Due to the COVID-19 pandemic, some planned medical activities have been postponed, for both national directives and out of concern of the patients who were afraid to go to hospitals.1 In our study we tried to evaluate if the pandemic has had any detrimental effect on melanoma diagnosis both in 2020 and 2021. Method(s): We collected all consecutive primary melanoma from the Pathology Registry of IDI-IRCCS of Rome (Breslow, ulceration and other main histological features). During year 2020 we divided the COVID-19 Italian pandemic into three phases: pre-lockdown (1 January- 9 March), lockdown (10 March-3 May), post-lockdown (4 May-6 June). We compared these data with the same period of year 2021. Result(s): In the year 2020 mean number of melanoma diagnoses per day were as follows: 2.3 in the pre-lockdown phase, 0.6 during the lockdown and 1.3 after the lockdown (in 20182019, we had 2.3/day). Mean Breslow thickness was 0.88 (95% CI, 0.501.26) pre-lockdown and 1.96 (95% CI, 1.162.76) post-lockdown. Proportion of ulceration was 5.9% (95% CI, 2.411.7%) pre-lockdown and 23.5% (95% CI 10.841.2%) post-lockdown. During the same period of year 2021 we observed a constant number of new melanoma cases, with a daily number similar to the 2020 pre-lockdown period. Overall, we observed a higher number of nodular melanoma and superficial spreading melanoma with nodule compared to 2020 pre-lockdown period. The proportion of in situ melanoma in 2021 (about 28%) is constant and it is very close to the observed values for 2018 (23.8%), 2019 (26.4%) and 2020 (25%). Conclusion(s): Our data support the hypothesis that during the COVID-19 lockdown period of year 2020, melanoma diagnoses may have been delayed. In 2020 a significant increase has been observed for men (from 0.96 to 2.70) but not for women (0.79 to 1.44), and in patients 50 years old or older. Regarding the year 2021, our data support the hypothesis that the number of new melanoma diagnoses returned to the pre-lockdown period, but the higher Breslow thickness and the largest number of thicker melanomas (nodular and superficial spreading with nodule) suggest it could be caused by the postponed prevention during the previous year. The constant proportion of in situ melanoma indicate that more health-conscious people were more likely to defy the 2020- 2021 lockdown limitations than people who might have been underestimating the severity of their lesions.