Prolactin as a Biomarker of Disease Activity in Autoimmune Bullous Disorders-A Case-Control Study.

BACKGROUND

Autoimmune bullous disorders (AIBDs) are autoantibody-mediated blistering diseases. Emerging evidence suggests a role for neuroendocrine factors, including prolactin, in modulating autoimmune responses.

AIM AND

OBJECTIVE

This study aimed to compare serum prolactin levels between patients with AIBDs and age- and sex-matched healthy controls, and to assess the correlation of prolactin levels with validated disease activity scores and autoantibody profiles across AIBD subtypes.

PATIENTS AND

METHODS

In this hospital-based case-control study (January 2022-December 2024), serum prolactin levels were compared between 32 patients with AIBD (16 pemphigus vulgaris [PV], 12 bullous pemphigoid [BP], 4 mucous membrane pemphigoid [MMP]) and 32 age- and sex-matched healthy controls. Prolactin was measured by chemiluminescent immunoassay. Disease activity was assessed using Pemphigus Disease Area Index (PDAI), Bullous Pemphigoid Disease Area Index (BPDAI), and Mucous Membrane Pemphigoid Disease Area Index (MMPDAI) score. Autoantibodies were quantified by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Median serum prolactin was significantly higher in AIBD patients (24.6 ng/mL, interquartile range [IQR] 18.3-32.1) than in controls (14.2 ng/mL, IQR 10.5-17.8; P < 0.001). Hyperprolactinemia was more frequent in patients (50% vs 6.2%; P < 0.001) and in those with active disease (63.6% vs 20% in remission; P = 0.002). Prolactin levels correlated with PDAI (r = 0.52, P = 0.008), BPDAI (r = 0.48, P = 0.012), and anti-desmoglein 3 (anti-Dsg3) titers in PV (r = 0.45, P = 0.018). Multivariate analysis confirmed AIBD diagnosis and active disease as independent predictors of elevated prolactin.

LIMITATIONS: Small sample size, cross-sectional, and single-center study design.

CONCLUSION

Serum prolactin is elevated in AIBD, particularly during active phases, and shows moderate correlation with disease severity and autoantibody levels. These findings suggest prolactin may serve as an adjunct biomarker, although the small sample size limits generalizability and further validation is required.