Autoimmune bullous dermatoses (ABD) compromise the skin's innate barrier function for preventing infection. Treating patients with ABD frequently requires systemic immunosuppressive therapy, often with multiple agents. Currently, no pretreatment infection testing guidelines are available for clinicians caring for patients with ABD. We performed a systematic literature review in other medical disciplines that use similar iatrogenic immunosuppressive medications to treat various diseases and conditions and developed infection-testing recommendations for patients with ABD before initiating immunosuppressive therapy. Assessing individual patient risk factors for latent infection and preventable communicable diseases can direct testing for select infections before starting immunosuppressive therapy. Testing patients for hepatitis B virus, hepatitis C virus, and Mycobacterium tuberculosis infection is recommended before initiating rituximab treatment. What's already known about this topic? Iatrogenic immunosuppressive therapy increases the risk of infection in patients with autoimmune bullous dermatoses (ABD). Infections are a common cause of morbidity and mortality in patients with ABD. What does this study add? Assessment of infection risk before initiating iatrogenic immunosuppression, on the basis of pre-existing guidelines, is important to prevent infection-associated morbidity and mortality in this unique patient population. We provide evidence-based laboratory screening recommendations for patients with ABD.
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