Autoimmune bullous dermatoses (ABDs) develop because of antibodies directed against antigens within the epidermis or at the dermoepidermal junction. They are classified histologically according to the location of acantholysis (separation of keratinocytes), clinical presentation and presence of autoantibodies. The commonest ABDs are pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid, which presents with a spectrum of symptoms and severity.

Multiple studies have evaluated the impact of bullous dermatoses on mental health; however, most were designed with a small sample size. A recent review analyzed additional relevant literature and systematically combined the data to determine the psychological burden of disease of ABDs, along with discussing the existing questionnaires frequently used in dermatology to evaluate unfavorable psychosocial symptoms.

The psychological state was evaluated using the General Health Questionnaire (GHQ)-28 and -12, in addition to the Hospital Anxiety and Depression Scale; the International Classification of Diseases, Tenth Revision; the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Beck Depression Inventory-II. 

• GHQ-12 positivity, describing probable minor nonpsychotic psychiatric disorders like depression and anxiety, was determined in 47%, 39.7% and 40% of patients with pemphigus; while GHQ-28 positivity was observed in 77.5% of pemphigus patients.
• The average population showed GHQ positivity in up to 12% of patients.
• Like the quality of life (QoL) scores, no significant differences were observed according to the subtype of pemphigus for symptoms of depression or anxiety.

Thus, it is evident that the patients with ABDs have lower QoL scores and higher numbers of psychological symptoms. Clinicians must consider this at-risk population and develop opportunities in the clinic to discuss personal hardship associated with the disease process and recommend psychiatric intervention if indicated. Additionally, family members who are often overburdened with the chronicity of ABDs too should be included. Using any of the aforementioned questionnaires will serve as a practical way to screen patients for lower QoL scores. Furthermore, besides the helpfulness of these questionnaires, clinicians must still determine if its use in clinical practice enhances patient satisfaction. 

Source: Riopelle A, Lake E. Bullous dermatoses and quality of life: a summary of tools to assess psychosocial health. Cutis. 2022;109(1): E14-E19.