The risk of COVID-19 in patients with bullous pemphigoid and pemphigus: A population-based cohort study

Khalaf Kridin*, Yochai Schonmann, Orly Weinstein, Enno Schmidt, Ralf J. Ludwig, Arnon D. Cohen

*Corresponding author for this work


Background: The burden of COVID-19 in patients with bullous pemphigoid (BP) and pemphigus is yet to be evaluated. Objective: To assess the risks of COVID-19 and COVID-19-associated hospitalization and mortality in patients with BP and pemphigus and to delineate determinants of severe COVID-19 illness among these patients. Methods: A population-based cohort study compared COVID-19 and its complications in patients with BP (n = 1845) and pemphigus (n = 1236) with age-, sex-, and ethnicity-matched control subjects. Results: The risks of COVID-19 (hazard rate [HR], 1.12; 95% confidence interval [CI], 0.72-1.73; P =.691) and COVID-19-associated hospitalization (HR, 1.58; 95% CI, 0.84-2.98; P =.160) was comparable between patients with BP and controls. The risk of COVID-19-associated mortality was higher among patients with BP (HR, 2.82; 95% CI, 1.15-6.92; P =.023). The risk of COVID-19 (HR, 0.81; 95% CI, 0.44-1.49; P =.496), COVID-19-associated hospitalization (HR, 1.41; 95% CI, 0.53-3.76; P =.499), and COVID-19-associated mortality (HR, 1.33; 95% CI, 0.15-11.92; P =.789) was similar in patients with pemphigus and their controls. Systemic corticosteroids and immunosuppressants did not predispose COVID-19-positive BP and pemphigus patients to a more severe illness. Limitations: Retrospective data collection. Conclusions: Patients with BP experience increased COVID-19-associated mortality and should be monitored closely. Maintaining systemic corticosteroids and immunosuppressive adjuvant agents during the pandemic is not associated with worse outcomes.

Original languageEnglish
JournalJournal of the American Academy of Dermatology
Issue number1
Pages (from-to)79-87
Number of pages9
Publication statusPublished - 07.2021

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)
  • Centers: Center for Research on Inflammation of the Skin (CRIS)

DFG Research Classification Scheme

  • 204-05 Immunology
  • 205-19 Dermatology

Coronavirus related work

  • Research on SARS-CoV-2 / COVID-19


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