Application Of ABSIS Score In Diagnosis And Treatment Of Pemphigus And Bullous Pemphigoid

Pemphigus is a group of chronic,recurrent autoimmune bullous diseases in which produce autoantibodies against extracellular domains of membrane proteins of keratinocytes.This process leads to acantholysis.Bullous pemphigoid is the most common autoimmune bullous disease characterized by autoantibodies against hemidesmosomal proteins and subepidermal bullas.How to quantify the severity of the disease and assess changes accurately,it is an important for clinicians to choose and adjust treatment plan.In 2007,Pfutze et al.introduced a scoring system applicable to all bullous dermatosis,namely ABSIS(Autoimmune Bullous Skin Disorder Intensity Score,ABSIS)score,which is a powerful tool for evaluating the severity of the disease.Method: 15 patients with pemphigus and 14 patients with bullous pemphigoid were identified in the department of dermatology of the second hospital of hebei medical university from November 2017 to October 2018.They were randomly divided into prednisone treatment group and prednisone combined with immunosuppressive therapy group.General information of the patients,ABSIS score and peripheral blood antibody ELISA value were recorded in each follow-up visit.The effective time of different treatment schemes,changes in ABSIS score,changes in antibody level,prednisone cumulative dose and so on were analysed by statistical methods.Results:1.After 3 months,ABSIS scores and antibody levels of pemphigus and bullous pemphigoid patients were significantly lower than the first visit with statistically significant differences(P < 0.05).2.The ABSIS score of pemphigus patients was correlated with the antibody level.There was a moderate correlation between the ELISA value of anti-dsg1 and ABSIS total score,ABSIS skin score.There was also a moderate correlation between the ELISA value of anti-dsg3 and ABSIS oral mucosa score(P < 0.05).Other correlations were weak or not significant.There was a moderate correlation between the ELISA value of anti-bp180 and ABSIS total score,ABSIS skin score and ABSIS oral mucosa in patients with bullous pemphigoid(P < 0.05).3.There were no significant differences in ABSIS total score reduction value,ABSIS skin reduction value,ABSIS oral mucosa reduction value,antibody ELISA reduction value,time of initial steroid dose reduction,time of the lesions complete regression,and steroid doses when the lesions were completely relieved between the hormone treatment group and hormone plus immunosuppressive treatment group in pemphigus patients(P > 0.05).But the differences in the initial dose of steroid and the total doses of steroid when the lesions were completely relieved between the hormone treatment group and hormone plus immunosuppressive treatment group was statistically significant(P<0.05).The glucocorticoid initial dose and cumulative dose could be reduced in the steroid combined immunosuppressive therapy group.There were no significant differences in ABSIS total score reduction value,ABSIS skin reduction value,ABSIS oral mucosa reduction value,antibody ELISA reduction value,time of initial steroid dose reduction,time of the lesions complete regression,the initial dose of steroid,steroid doses when the lesions were completely relieved and the total doses of steroid between the two groups in pemphigus patients(P > 0.05).Conclusion: There is a correlation between ABSIS score and antibody level in pemphigus and bullous pemphigoid patients,and it can be used to monitor changes in patients’ condition and guide the choice of treatment.