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Nonbullous pemphigoid: A systematic review. J Am Acad Dermatol 2017; 78:989-995.e2. [PMID: 29102490 DOI: 10.1016/j.jaad.2017.10.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bullous pemphigoid is an autoimmune disease that typically presents with tense bullae and severe pruritus. However, bullae can be lacking, a subtype termed nonbullous pemphigoid. OBJECTIVE To summarize the reported characteristics of nonbullous pemphigoid. METHODS The EMBASE and MEDLINE databases were searched using "nonbullous pemphigoid" and various synonyms. Case reports and series describing nonbullous pemphigoid were included. RESULTS The search identified 133 articles. After selection, 39 articles were included, presenting 132 cases. Erythematous, urticarial plaques (52.3%) and papules/nodules (20.5%) were the most reported clinical features. The mean age at presentation was 74.9 years. Histopathology was commonly nonspecific. Linear depositions of IgG and/or C3 along the basement membrane zone were found by direct immunofluorescence microscopy in 93.2%. Indirect immunofluorescence on salt-split skin was positive in 90.2%. The mean diagnostic delay was 22.6 months. A minority of patients (9.8%) developed bullae during the reported follow-up. LIMITATIONS Results are mainly based on case reports and small case series. CONCLUSION Nonbullous pemphigoid is an underdiagnosed variant of pemphigoid that most often does not evolve to bullous lesions and mimics other pruritic skin diseases. Greater awareness among physicians is needed to avoid delay in diagnosis.
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Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade: Clinicopathologic Analysis of the Nonlichenoid Histologic Pattern. Am J Surg Pathol 2017; 41:1381-1389. [PMID: 28817405 DOI: 10.1097/pas.0000000000000900] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cutaneous eruptions are among the most common immune-related adverse events (irAEs) associated with anti-programmed cell death protein 1/programmed cell death ligand 1 therapy, and are often clinically and histologically characterized as lichenoid. Nonlichenoid patterns may also occur and are likely to be encountered by surgical pathologists, given the increasing clinical use of these agents. The purpose of this study is to describe the histopathologic features of nonlichenoid cutaneous irAEs from patients receiving anti-programmed cell death protein 1/programmed cell death ligand 1 therapies for a variety of underlying advanced malignancies. Sixteen patients with 17 biopsied eruptions were included from 2 academic institutions with extensive experience administering and monitoring responses to immune checkpoint blockade as well as treating the potential side effects. Eruptions occurred a median of 10 days (range, 1 d to 11.4 mo) after treatment initiation. Nearly half of specimens demonstrated either a psoriasiform/spongiotic or an urticarial-type reaction pattern on histologic review. Patterns consistent with Grover disease, bullous pemphigoid, and granulomatous dermatitis were also observed. Nearly two-thirds of patients required systemic corticosteroids for treatment of the cutaneous irAE, and 19% of patients discontinued immunotherapy due to their skin eruptions. 75% of patients showed an objective antitumor response. The diverse array of nonlichenoid cutaneous irAE presented here should reflect and inform the scope of histologic patterns encountered by the practicing surgical pathologist. Such eruptions are seen in patients with a variety of underlying tumor types, many of whom ultimately demonstrate a favorable response to immune checkpoint blockade.
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Bağcı IS, Horváth ON, Ruzicka T, Sárdy M. Bullous pemphigoid. Autoimmun Rev 2017; 16:445-455. [DOI: 10.1016/j.autrev.2017.03.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
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Huet F, Karam A, Lemasson G, Jouen F, Sonbol H, Misery L, Abasq-Thomas C. Image Gallery: Erythroderma revealing a nonbullous bullous pemphigoid. Br J Dermatol 2016; 175:e136-e137. [DOI: 10.1111/bjd.14982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F. Huet
- Department of Dermatology and Venereology; University Hospital of Brest; 29609 Brest France
| | - A. Karam
- Department of Dermatology and Venereology; University Hospital of Brest; 29609 Brest France
| | - G. Lemasson
- Department of Pathology; University Hospital of Brest; 29609 Brest France
| | - F. Jouen
- Laboratory of Immunology; University Hospital of Rouen; Rouen France
| | - H. Sonbol
- Department of Dermatology and Venereology; University Hospital of Brest; 29609 Brest France
| | - L. Misery
- Department of Dermatology and Venereology; University Hospital of Brest; 29609 Brest France
| | - C. Abasq-Thomas
- Department of Dermatology and Venereology; University Hospital of Brest; 29609 Brest France
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Imbernón-Moya A, Aguilar A, Burgos F, Gallego MÁ. Erythema Multiforme-Like Bullous Pemphigoid. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:689-91. [PMID: 27048923 DOI: 10.1016/j.ad.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/03/2015] [Accepted: 02/21/2016] [Indexed: 10/22/2022] Open
Affiliation(s)
- A Imbernón-Moya
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - A Aguilar
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - F Burgos
- Servicio de Anatomía Patológica, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - M Á Gallego
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
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Imbernón-Moya A, Aguilar A, Burgos F, Gallego M. Erythema Multiforme-Like Bullous Pemphigoid. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Porriño-Bustamante ML, Alfageme F, Suárez L, de Domingo MAG, Hospital M, Roustán G. High-Frequency Color Doppler Sonography of Bullous Pemphigoid: Correlation With Histologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1821-5. [PMID: 27371374 DOI: 10.7863/ultra.15.09079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 06/06/2023]
Abstract
Bullous pemphigoid is the most frequent autoimmune-mediated blistering skin disease, belonging to the group of subepidermal bullae. We performed high-frequency color Doppler sonography in 3 cases of bullous pemphigoid, in bullous and adjacent non-bullous skin, which showed homogeneous sonographic findings. Subepidermal cystic structures with dermal hypoechogenicity were observed in bullous skin. In nonbullous skin, the dermis showed hypoechogenicity compared to normal skin. Color Doppler signals were increased in both areas. These findings correlate histologically with subepidermal bullae and dermal inflammatory infiltrates.
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Affiliation(s)
| | - Fernando Alfageme
- Department of Dermatology, Ultrasound Learning Center Madrid, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Lola Suárez
- Department of Pathology, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Mercedes Hospital
- Department of Dermatology, Ultrasound Learning Center Madrid, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Gastón Roustán
- Department of Dermatology, Ultrasound Learning Center Madrid, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Kabuto M, Fujimoto N, Tanaka T. Two cases of annular erythema without bullous lesions by autoimmune blistering diseases. Mod Rheumatol 2015; 28:200-202. [PMID: 26382039 DOI: 10.3109/14397595.2015.1081721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although annular erythema is usually observed as one of the cutaneous manifestations of Sjögren's syndrome or subacute cutaneous lupus erythematosus, autoimmune blistering diseases also present with annular erythema. However, bullous lesions are not always found, and there is a rare type without bullous lesions. We present two cases of autoimmune blistering diseases showing annular erythema without bullous lesions. It is important to perform direct or indirect immunofluorescence examination when we encounter multiple annular erythema.
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Affiliation(s)
- Miho Kabuto
- a Department of Dermatology , Shiga University of Medical Science , Setatsukinowa , Otsu , Shiga , Japan
| | - Noriki Fujimoto
- a Department of Dermatology , Shiga University of Medical Science , Setatsukinowa , Otsu , Shiga , Japan
| | - Toshihiro Tanaka
- a Department of Dermatology , Shiga University of Medical Science , Setatsukinowa , Otsu , Shiga , Japan
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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