{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:02:09Z","timestamp":1785823329092,"version":"3.56.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100017596","name":"Natural Science Basic Research Program of Shaanxi Province","doi-asserted-by":"publisher","award":["2023-JC-QN-0864"],"award-info":[{"award-number":["2023-JC-QN-0864"]}],"id":[{"id":"10.13039\/501100017596","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bullous pemphigoid (BP) exhibits significant clinical heterogeneity. The molecular drivers underlying these distinct phenotypes remain poorly understood, hindering the development of precision medicine approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To correlate clinical phenotypes, defined by the Bullous Pemphigoid Disease Area Index (BPDAI), with molecular endotypes using serum proteomic profiling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study enrolled 143 patients with BP hospitalized at a tertiary centre between January 2024 and June 2025. Patients were stratified as having inflammatory BP (I-BP; BPDAI urticaria\/erythema subscore \u2265 5) and pauci-inflammatory BP (PI-BP; BPDAI urticaria\/erythema subscore &amp;lt; 5) based on the first quartile of the subscore. Clinical features, laboratory parameters and treatment outcomes were compared. Serum proteomic profiling (Olink Target 96 Inflammation) was performed in a representative subset (n = 37).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 143 enrolled patients [mean (SD) age 73.9 (11.2) years; 84 (58.7%) men], 108 (75.5%) were classified as having I-BP and 35 (24.5%) as having PI-BP. Compared with those with PI-BP, patients with I-BP were younger, had more severe pruritus and had significantly elevated peripheral eosinophil counts (0.6 vs. 0.2 \u00d7 109 cells L\u20131; P = 0.001) and serum interleukin (IL)-5 levels (19.8 vs. 3.9 pg mL\u20131; P = 0.007). Despite receiving more intensive therapy, patients with I-BP required a longer median hospital stay (8 vs. 7\u2005days; P = 0.03). Proteomic analysis identified eight differentially expressed proteins. IL-13, thymic stromal lymphopoietin, oncostatin M and monocyte chemoattractant protein-4 were upregulated in I-BP and showed positive correlation with the urticaria\/erythema subscore (P &amp;lt; 0.05) but not with the erosions\/blisters subscore. IL-13 demonstrated the highest diagnostic accuracy for the I-BP endotype (area under the curve = 0.87). Functional enrichment analysis confirmed differential activation of type 2 inflammation and the Janus kinase\/signal transducers and activators of transcription (JAK\/STAT) signalling pathway in the I-BP group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BPDAI urticaria\/erythema subscore serves as a reliable clinical surrogate for a T helper 2 (Th2)-driven molecular endotype in BP. The identification of a specific Th2 ligand\u2013JAK\/STAT signalling circuit in the inflammatory phenotype supports a stratified treatment approach, suggesting that patients with a high inflammatory burden may benefit from targeted type 2 immunotherapies or JAK inhibitors, which warrants further prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjd\/ljag156","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:28:25Z","timestamp":1776770905000},"page":"293-303","source":"Crossref","is-referenced-by-count":3,"title":["A clinically actionable stratification of bullous pemphigoid using a disease activity score reveals a targetable inflammatory endotype"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3130-2744","authenticated-orcid":false,"given":"Zhiqiang","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Dermatology, Northwest Hospital, The Second Affiliated 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,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueran","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delu","family":"Che","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an ,","place":["China"]},{"name":"Center for Dermatology Disease, Precision Medical Institute , Xi\u2019 an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baobao","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Gui","sequence":"additional","affiliation":[{"name":"Department of Pediatric, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Raap","sequence":"additional","affiliation":[{"name":"Division of Experimental Allergy and Immunodermatology, School\u00a0of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg , Oldenburg ,","place":["Germany"]},{"name":"Research Center for Neurosensory Science, Carl von Ossietzky University Oldenburg , Oldenburg 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