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Review

The Role of Microbiota in the Pathogenesis of Bullous Pemphigoid and Pemphigus Vulgaris: Evidence, Controversies, and Perspectives

by
Francesca Gorini
1,*,
Alessio Coi
1,
Michele Santoro
1,
Alessandro Tonacci
2,
Francesco Sansone
2,
Elena Biancamaria Mariotti
3,
Marta Donati
4,
Alice Verdelli
4,
Maria Rita Nasca
5,
Paolo Amerio
6,
Emiliano Antiga
4,
Emanuela Barletta
7 and
Marzia Caproni
4
1
Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
2
Information Systems Unit, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
3
Department of Health Sciences, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50122 Florence, Italy
4
Department of Health Sciences, Section of Dermatology, University of Florence, P. Palagi Hospital, 50122 Florence, Italy
5
Dermatology Clinic, University of Catania, 95123 Catania, Italy
6
Dermatologic Clinic, G. D’Annunzio University, 66100 Chieti, Italy
7
Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Experimental Pathology and Oncology Section, University of Florence, 50134 Firenze, Italy
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2025, 26(13), 6076; https://doi.org/10.3390/ijms26136076
Submission received: 5 June 2025 / Revised: 22 June 2025 / Accepted: 23 June 2025 / Published: 24 June 2025
(This article belongs to the Special Issue The Role of Dysbiosis in Chronic Diseases)
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Abstract

Bullous pemphigoid (BP) and pemphigus vulgaris (PV) represent the most prevalent conditions among autoimmune bullous skin diseases, considered a major cause of severe morbidity and, in certain cases, mortality. The hallmark of the two diseases is the presence of autoantibodies directed against proteins located in the basement membrane of the skin, which determines the formation of blisters. In recent years, interest in the role of microbiota in relation to health-disease status has progressively increased. In particular, based on the gut–skin axis, accumulating evidence has emerged on the potential association between the composition and diversity of microbial communities in the gut, skin, and even in the oral cavity and the risk of developing BP and PV. Dysbiosis, characterized by a generally higher relative abundance of Firmicutes and a depletion of probiotics/beneficial species, might contribute to the pathogenesis of both diseases. Despite the still limited number of studies and the need for further large-scale multicenter studies, the knowledge gathered so far is suggestive of a novel modifiable risk factor representing a potential target for adjuvant treatments of these disabling and life-threatening conditions.
Keywords: bullous pemphigoid; pemphigus vulgaris; autoimmune bullous skin diseases; gut microbiota; oral microbiota; skin microbiota; probiotics bullous pemphigoid; pemphigus vulgaris; autoimmune bullous skin diseases; gut microbiota; oral microbiota; skin microbiota; probiotics

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MDPI and ACS Style

Gorini, F.; Coi, A.; Santoro, M.; Tonacci, A.; Sansone, F.; Mariotti, E.B.; Donati, M.; Verdelli, A.; Nasca, M.R.; Amerio, P.; et al. The Role of Microbiota in the Pathogenesis of Bullous Pemphigoid and Pemphigus Vulgaris: Evidence, Controversies, and Perspectives. Int. J. Mol. Sci. 2025, 26, 6076. https://doi.org/10.3390/ijms26136076

AMA Style

Gorini F, Coi A, Santoro M, Tonacci A, Sansone F, Mariotti EB, Donati M, Verdelli A, Nasca MR, Amerio P, et al. The Role of Microbiota in the Pathogenesis of Bullous Pemphigoid and Pemphigus Vulgaris: Evidence, Controversies, and Perspectives. International Journal of Molecular Sciences. 2025; 26(13):6076. https://doi.org/10.3390/ijms26136076

Chicago/Turabian Style

Gorini, Francesca, Alessio Coi, Michele Santoro, Alessandro Tonacci, Francesco Sansone, Elena Biancamaria Mariotti, Marta Donati, Alice Verdelli, Maria Rita Nasca, Paolo Amerio, and et al. 2025. "The Role of Microbiota in the Pathogenesis of Bullous Pemphigoid and Pemphigus Vulgaris: Evidence, Controversies, and Perspectives" International Journal of Molecular Sciences 26, no. 13: 6076. https://doi.org/10.3390/ijms26136076

APA Style

Gorini, F., Coi, A., Santoro, M., Tonacci, A., Sansone, F., Mariotti, E. B., Donati, M., Verdelli, A., Nasca, M. R., Amerio, P., Antiga, E., Barletta, E., & Caproni, M. (2025). The Role of Microbiota in the Pathogenesis of Bullous Pemphigoid and Pemphigus Vulgaris: Evidence, Controversies, and Perspectives. International Journal of Molecular Sciences, 26(13), 6076. https://doi.org/10.3390/ijms26136076

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