{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:44:29Z","timestamp":1760150669834,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T00:00:00Z","timestamp":1703548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Autoimmune bullous diseases (ABDs) are a rare but significant group of dermatoses that pose great challenges to the treating dermatologist. ABDs are characterized by the presence of tissue-bound and circulating autoantibodies directed against disease-specific target antigens of the skin. Most epidemiological studies have focused on a single ABD. More than that, there are few data about the incidence and prevalence of autoimmune blistering diseases in Romania. Methods: In this study, between 2015 and 2019, we retrospectively investigated a total of 225 patients with autoimmune bullous diseases from the northeastern region of Romania. The diagnosis was based on the clinical and histo- and immunohistological findings. Results: Pemphigus was the most frequently encountered ABD, with an incidence of 8.16\/1,000,000 inhabitants, representing 58.7% (132 cases), followed by 24% cases of bullous pemphigoid (54 cases), 15.4% of patients were diagnosed with dermatitis herpetiformis (37 cases), and 0.9% other subepidermal autoimmune bullous dermatoses. The average age of onset of pemphigus vulgaris was 59.4 years, the majority of patients being male, while the average age of patients diagnosed with bullous pemphigoid was 73.8 years, the majority being female. Conclusions: Pemphigus vulgaris is the most frequently encountered ABDs in the northeast of Romania, with a higher incidence than in Western European countries, and this may be due to specific peculiarities of the geographical area, as well as to a genetic susceptibility of the population in this region.<\/jats:p>","DOI":"10.3390\/diagnostics14010057","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T05:43:15Z","timestamp":1703655795000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological Study of Autoimmune Bullous Dermatoses in Northeastern Romania"],"prefix":"10.3390","volume":"14","author":[{"given":"Ioana Adriana","family":"Popescu","sequence":"first","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2755-6004","authenticated-orcid":false,"given":"Dan","family":"Vata","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doinita","family":"Temelie Olinici","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Marian","family":"Tarcau","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana Ionela","family":"Patrascu","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana Alina","family":"Halip","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dumitrita Lenuta","family":"Gugulus","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madalina","family":"Mocanu","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Gheuca Solovastru","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jaci.2020.02.013","article-title":"Autoimmune bullous skin diseases, pemphigus and pemphigoid","volume":"145","author":"Egami","year":"2020","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s00403-014-1531-1","article-title":"Geographic variations in epidemiology of two autoimmune bullous diseases: Pemphigus and bullous pemphigoid","volume":"307","author":"Alpsoy","year":"2015","journal-title":"Arch. Dermatol. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.clindermatol.2011.03.016","article-title":"Quality of life in patients with bullous dermatoses","volume":"30","author":"Sebaratnam","year":"2012","journal-title":"Clin. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Moro, F., Fania, L., Sinagra, J.L.M., Salemme, A., and Di Zenzo, G. (2020). Bullous Pemphigoid: Trigger and Predisposing Factors. Biomolecules, 10.","DOI":"10.3390\/biom10101432"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/jdi.13676","article-title":"Association between dipeptidyl peptidase-4 inhibitors and increased risk for bullous pemphigoid within 3 months from first use: A 5-year population-based cohort study using the Japanese National Database","volume":"13","author":"Kuwata","year":"2022","journal-title":"J. Diabetes Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"779","DOI":"10.3389\/fimmu.2018.00779","article-title":"Humoral Epitope Spreading in Autoimmune Bullous Diseases","volume":"9","author":"Didona","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/S0140-6736(19)31778-7","article-title":"Pemphigus","volume":"394","author":"Schmidt","year":"2019","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/j.1365-4632.2004.02533.x","article-title":"Pemphigus in the Mediterranean region of Turkey: A study of 148 cases","volume":"45","author":"Uzun","year":"2004","journal-title":"Int. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/S0140-6736(12)61140-4","article-title":"Pemphigoid diseases","volume":"381","author":"Schmidt","year":"2013","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.jaad.2010.09.777","article-title":"Dermatitis herpetiformis. Part I. Epidemiology, pathogenesis, and clinical presentation","volume":"64","author":"Bolotin","year":"2011","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100004","DOI":"10.1016\/j.xjidi.2021.100004","article-title":"Epidemiology of Pemphigus","volume":"1","author":"Kridin","year":"2021","journal-title":"JID Innov."},{"key":"ref_12","first-page":"410","article-title":"Pemphigus in Israel\u2014An epidemiologic analysis of cases in search of risk factors","volume":"5","author":"Wohl","year":"2003","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1684\/ejd.2016.2792","article-title":"Epidemiological data of 290 pemphigus vulgaris patients: A 29-year retrospective study","volume":"26","author":"Baum","year":"2016","journal-title":"Eur. J. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1111\/j.1365-4632.2009.04345.x","article-title":"Pemphigus vulgaris is the most common autoimmune bullous disease in Northwestern Romania","volume":"49","author":"Baican","year":"2010","journal-title":"Int. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s40257-020-00584-2","article-title":"Dermatitis Herpetiformis: An Update on Diagnosis and Management","volume":"22","author":"Reunala","year":"2021","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/j.1346-8138.2011.01382.x","article-title":"Quality of life and psychological status of patients with pemphigus vulgaris using Dermatology Life Quality Index and General Health Questionnaires","volume":"39","author":"Ghodsi","year":"2011","journal-title":"J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/ijd.14201","article-title":"Autoimmune skin disease among dermatology outpatients in Botswana: A retrospective review","volume":"58","author":"Madu","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1046\/j.1365-4362.2000.00864.x","article-title":"Epidemiology of pemphigus in Sofia, Bulgaria. A 16-year retrospective study (1980\u20131995)","volume":"39","author":"Tsankov","year":"2000","journal-title":"Int. J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.det.2011.07.003","article-title":"Autoimmune Blistering Diseases: Incidence and Treatment in Croatia","volume":"29","author":"Marinovic","year":"2011","journal-title":"Dermatol. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2340\/0001555562491496","article-title":"Pemphigus: An epidemiological study of patients treated in Finnish hospitals between 1969 and 1978","volume":"62","author":"Hietanen","year":"1982","journal-title":"Acta Derm.-Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000261503","article-title":"Incidence of auto-immune pemphigus in the Midi-Pyr\u00e9n\u00e9es region in 2002-2006","volume":"220","author":"Thomas","year":"2010","journal-title":"Dermatology"},{"key":"ref_22","first-page":"434","article-title":"Prospective analysis of the incidence of autoimmune bullous disorders in Lower Franconia, Germany","volume":"7","author":"Bertram","year":"2009","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/j.1365-4632.2006.03044.x","article-title":"Epidemiologic survey of pemphigus vulgaris with oral manifestations in northern Greece: Retrospective study of 129 patients","volume":"46","author":"Michailidou","year":"2007","journal-title":"Int. J. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"349","DOI":"10.4103\/0378-6323.42901","article-title":"Incidence of pemphigus in Thrissur district, south India","volume":"74","author":"Kumar","year":"2008","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/0030-4220(74)90365-X","article-title":"Pemphigus vulgaris: Incidence in Jews of different ethnic groups, according to age, sex, and initial lesion","volume":"38","author":"Pisanti","year":"1974","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jaad.2016.06.055","article-title":"Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region","volume":"75","author":"Kridin","year":"2016","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/j.1365-4632.2004.02501.x","article-title":"Pemphigus: Analysis of 1209 cases","volume":"44","author":"Valikhani","year":"2005","journal-title":"Int. J. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1046\/j.1365-4362.1998.00428.x","article-title":"Epidemiologic analysis and clinical course of 84 consecutive cases of pemphigus in eastern Sicily","volume":"37","author":"Micali","year":"1998","journal-title":"Int. J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1365-4632.2006.03010.x","article-title":"Epidemiology of pemphigus in Macedonia: A 15-year retrospective study (1990\u20132004)","volume":"46","author":"Laskoski","year":"2007","journal-title":"Int. J. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1111\/ijd.14078","article-title":"Incidence of pemphigus vulgaris and pemphigus foliaceus in North-East Poland (Podlaskie Province)\u2014A 15-year (2001\u20132015) bicentric retrospective study","volume":"57","author":"Serwin","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1111\/j.1365-4632.2004.02421.x","article-title":"Some epidemiological features of pemphigus chronicus in South Vojvodina: A 12-year retrospective study","volume":"44","author":"Golusin","year":"2005","journal-title":"Int. J. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1111\/bjd.17346","article-title":"Epidemiological and genetic data suggest the presence of an endemic form of pemphigus foliaceus in Gran Canaria, Spain","volume":"180","author":"Rey","year":"2019","journal-title":"Br. J. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1111\/j.1365-2133.2009.09300.x","article-title":"Incidence of bullous pemphigoid and pemphigus in Switzerland: A 2-year prospective study","volume":"161","author":"Marazza","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/jid.2011.249","article-title":"Incidence, Mortality, and Causes of Death of Patients with Pemphigus in Taiwan: A Nationwide Population-Based Study","volume":"132","author":"Huang","year":"2012","journal-title":"J. Investig. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jdermsci.2020.08.002","article-title":"National trends in incidence, mortality, hospitalizations, and expenditures for pemphigus in Taiwan","volume":"99","author":"Chiu","year":"2020","journal-title":"J. Dermatol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1111\/j.1365-4632.2010.04801.x","article-title":"Spectrum of autoimmune blistering dermatoses in Tunisia: An 11-year study and a review of the literature","volume":"50","author":"Zaraa","year":"2011","journal-title":"Int. J. Dermatol."},{"key":"ref_37","first-page":"181","article-title":"Epidemiology of Pemphigus in Turkey: One-year Prospective Study of 220 Cases","volume":"25","author":"Yayli","year":"2017","journal-title":"Acta Dermatovenerol. Croat."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"a180","DOI":"10.1136\/bmj.a180","article-title":"Bullous pemphigoid and pemphigus vulgaris\u2014Incidence and mortality in the UK: Population based cohort study","volume":"337","author":"Langan","year":"2008","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1001\/archderm.1980.01640330073017","article-title":"Pemphigus in Hartford County, Connecticut, from 1972 to 1977","volume":"116","author":"Simon","year":"1980","journal-title":"Arch. Dermatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:42:21Z","timestamp":1760132541000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,26]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["diagnostics14010057"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14010057","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,12,26]]}}}