It is well

known that the inflammatory response inhibits fibrinolysis, which contributes to the prothrombotic state seen in conditions such as sepsis [16], inflammatory bowel diseases [17] and rheumatoid arthritis [18]. However, to the best of our knowledge, no data are available concerning systemic fibrinolysis in BP patients, although it has been shown to be involved at local level LDK378 mw in lesional skin in humans and experimental BP models [19-23]. With this background, we evaluated systemic fibrinolysis by measuring the plasma parameters of 20 patients with BP in an active phase and in clinical remission after systemic corticosteroid treatment, and correlated the results with coagulation

markers and the parameters of disease activity. We conducted an observational study enrolling 20 consecutive patients with previously untreated active BP (10 males and 10 females; mean age 76 years, range 53–99) who were admitted to our Dermatology Department from January 2010 to June 2011. The diagnosis of BP was established on the basis of clinical and immunopathological criteria. All the patients had a clinical picture of generalized BP without any mucous membrane involvement GW 572016 (mean disease duration: 1 month, range 0–2); the skin lesions (vesiculobullous and/or erythematous–oedematous lesions) covered a median 40% of total body area (range 20–60%). Direct immunofluorescence examinations of the perilesional skin revealed the linear deposition of IgG and/or C3 in the BMZ in all cases, Alanine-glyoxylate transaminase circulating anti-BP180 autoantibodies were detected by means of an ELISA. Concomitant neoplastic or inflammatory diseases were excluded on the basis of clinical and instrumental examinations. None of the patients had thyroid dysfunction or atrial fibrillation and were taking drugs affecting coagulation. Three of the 20 BP patients had type 2 diabetes and were receiving treatment with oral anti-diabetic drugs with an acceptable

disease control (haemoglobin A1c values 6·5, 6·7 and 7·0, respectively). After taking the blood samples, patients with active disease were treated with methylprednisolone at an initial dose of 0·5–0·75 mg/kg/day. When either new lesions or pruritic symptoms have not occurred for at least 2 weeks, the tapering of steroid was started until reaching the minimal dose of 0·05–0·1 mg/kg/day. All the patients were also studied during clinical remission, defined as the absence of any new BP lesions with the complete healing of the previous lesions for a minimum of 4 weeks. At the time of sampling, they were being treated with low-dose corticosteroids (methylprednisolone 4 mg daily). The control group consisted of 20 age- and sex-matched apparently healthy subjects with no history of thrombosis (10 males and 10 females; mean age 75 years, range 55–94).