We aimed to evaluate the impact of dementia on BP diagnosis, treatment, and management.

The incidence of BP, the most common autoimmune blistering disorder of the skin and mucosa, is rising. Epidemiological evidence has implicated neurological comorbidities, particularly dementia. Recent work has demonstrated a statistically significant association with BP independent of age. However, the clinicopathological characteristics, disease course, and management considerations of BP in this subgroup remain poorly defined. In older adults, BP often follows a chronic, relapsing course and confers functional decline, which cognitive impairment may exacerbate. By minimizing selection biases inherent to hospital-based cohorts, individual-level reports may provide granular insight into unique considerations of real-world, dementia care.

We systematically reviewed literature across PubMed, Web of Science, and EMBASE, identifying patients with dementia from case reports and series who developed BP. Outcomes included categories of presentation (medical history, physical examination findings, and time-to-presentation), intervention (diagnostic and treatment strategies), and management (follow-up and complications).

The 13 patients (mean age 84.3 years; 9 female) spanned several dementia subtypes: Alzheimer’s (n=7), Lewy body (n=1), vascular (n=1), and unspecified (n=4). Median time to BP diagnosis was 35 days. 3 patients had clear neurological medication or vaccine triggers. 10 patients presented with typical cutaneous findings. Biopsy was deferred for comfort in 2 patients. Only 1 patient was initially managed with a steroid-sparing agent. In 2 patients, incomplete response necessitated treatment modification. 2 patients died from unrelated complications after intervention, while one was lost to follow-up.

Our findings indicate BP may carry diagnostic delays and treatment decision challenges in patients with dementia. Clinicians are already responding, individualizing management for this fragile group. However, as cases continue to increase, guidance to support clinical decision-making is necessary and should motivate future studies exploring potential dementia-BP mechanisms, risk factors, and therapeutic regimens.