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Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol 2019; 20:97-114. [PMID: 30361953 DOI: 10.1007/s40257-018-0400-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases in the USA. If uncontrolled, diabetes can lead to devastating complications. Diabetes medications and medical devices largely contribute to the significant financial expense that the disease inflicts on affected individuals and society. Alongside significant economic burden, there are numerous cutaneous adverse effects associated with diabetes medications and medical devices. Despite the large and increasing number of individuals living with diabetes and the wide use of the related medications and medical devices, there is limited literature that comprehensively documents their cutaneous adverse effects. These cutaneous adverse effects are significant as they can worsen glycemic control, increase disease distress, and may increase risk of associated complications. Thus, it is important that providers can recognize these cutaneous adverse effects, identify the culprit agents, and can properly manage them. In this article, we provide a critical review of the cutaneous adverse effects of medications and devices used in the management of diabetes and provide insight into risk factors and prevention and an overview of therapeutic management. An emphasis is placed on clinical recognition and treatment for use of the medical providers who, regardless of practice setting, will treat patients with diabetes.
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Wittenberg M, Worm M. Severe Refractory Paraneoplastic Mucous Membrane Pemphigoid Successfully Treated With Rituximab. Front Med (Lausanne) 2019; 6:8. [PMID: 30761304 PMCID: PMC6362419 DOI: 10.3389/fmed.2019.00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease of the mucous membranes, which can cause irreversible scarring and is discussed to be associated with cancer, if laminin-332-autoantibodies are present. MMP with severe ocular and laryngeal involvement is difficult to treat and can be treatment-refractory to conventional immunosuppressant therapy. A 67-year-old man with a history of prostate cancer presented to our clinic with sore throat, intraoral bullae, odynophagia, dysphonia, exertional dyspnea, and erosions of the glans penis. Clinical examination confirmed a laryngo-pharyngitis with involvement of the epiglottis and bilateral symblepharon. Diagnostics comprising multiple biopsies, direct and indirect immunofluorescence, serology analysis, and immunoblotting confirmed the diagnosis of a paraneoplastic MMP by showing a subepithelial split in histology and the presence of anti-laminin-332-antibodies. Despite combined systemic treatment with prednisolone and either dapsone or azathioprine, a progress of the disease occurred leading to severe ocular and laryngeal complications. Two month after rituximab treatment, complete disease control was achieved. This case report shows a severe ocular and life threatening laryngeal involvement of therapy-refractory paraneoplastic MMP highlighting the importance of interdisciplinary management and difficulty of diagnosing MMP despite repeated diagnostic testing.
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Affiliation(s)
- Marcel Wittenberg
- Department of Dermatology, Venerology and Allergology, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venerology and Allergology, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Gilvetti C, Collyer J, Gulati A, Barrett AW. What is the optimal site and biopsy technique for the diagnosis of oral mucosal autoimmune blistering disease? J Oral Pathol Med 2019; 48:239-243. [DOI: 10.1111/jop.12817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit Queen Victoria Hospital East Grinstead UK
| | - Jeremy Collyer
- Maxillofacial Unit Queen Victoria Hospital East Grinstead UK
| | - Aakshay Gulati
- Maxillofacial Unit Queen Victoria Hospital East Grinstead UK
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Long-Term Follow-Up after Intravenous Immunoglobulin Therapy in Patients with Severe Ocular Mucous Membrane Pemphigoid Unresponsive to Conventional Therapy. J Ophthalmol 2018; 2018:8372146. [PMID: 30327726 PMCID: PMC6169236 DOI: 10.1155/2018/8372146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a heterogeneous group of rare, systemic, autoimmune subepidermal inflammatory disease that affects mucous membranes and the eye. In its most severe forms, this disease needs systemic therapy, usually based on steroids and immunosuppressant agents. In unresponsive cases or in the presence of contraindications or severe side effects due to conventional systemic corticosteroid and/or immunosuppressant therapy, a therapy shift to high-dose intravenous immunoglobulins (IVIg) has been recommended in other reports. This new therapy has proven to be effective in stopping ocular pemphigoid, but the data regarding the long-term effect on the disease activity or reactivation are extremely scarce, so the novel scientific aim of this study was to evaluate the clinical outcomes after a 9-year follow-up in 12 eyes (6 patients) affected by MMP with ocular involvement, successfully treated with IVIg therapy, as previously described in our report published in 2008. The evaluation of ocular and extraocular disease progression was performed at the end of IVIg therapy and at the end of the follow-up period. After 9 years, all the eyes enrolled showed a long-lasting remission of ocular and oral symptoms with a significant steroid-sparing effect. In conclusion, the IVIg has to be considered as a safe and successful alternative therapy in patients with severe ocular mucous membrane pemphigoid; furthermore, this kind of therapy seems to be effective in maintaining the clinical remission by the time.
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55
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Porter SR, Mercadante V, Fedele S. Oral manifestations of systemic disease. Br Dent J 2018; 223:683-691. [PMID: 29123296 DOI: 10.1038/sj.bdj.2017.884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
While the majority of disorders of the mouth are centred upon the direct action of plaque, the oral tissues can be subject to change or damage as a consequence of disease that predominantly affects other body systems. Such oral manifestations of systemic disease can be highly variable in both frequency and presentation. As lifespan increases and medical care becomes ever more complex and effective it is likely that the numbers of individuals with oral manifestations of systemic disease will continue to rise. The present article provides a succinct review of oral manifestations of systemic disease. In view of this article being part of a wider BDJ themed issue on the subject of oral medicine, this review focuses upon oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease.
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Affiliation(s)
- S R Porter
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD
| | - V Mercadante
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD
| | - S Fedele
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD.,UCL NIHR Biomedical Research Centre
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Abstract
Autoimmune bullous diseases (AIBD), including pemphigus, bullous pemphigoid, epidermolysis bullosa acquisita, mucous membrane pemphigoid, and pemphigoid gestationis, pose significant therapeutic challenges, especially in pregnant and post-partum breastfeeding patients or those planning to conceive. Data on the safety and efficacy of therapeutic interventions during the perinatal period are lacking because randomized controlled trials are typically not performed in this setting. However, many of the treatments for AIBD are also used in other diseases, so data can be extrapolated from studies or case reports in these other patient populations. It appears that many of the treatments for AIBD can adversely affect the fetus or neonate, and alterations in immune status caused by pregnancy-associated hormonal changes can negatively impact disease control. This article summarizes and weighs the risks and benefits of the various agents used to treat AIBD during pregnancy. We also present the available information on lactation as well as effects on male fertility.
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Affiliation(s)
- Carolyn J Kushner
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
- Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, 2 East Gates, Room 2075, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Josef Symon S Concha
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
- Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, 2 East Gates, Room 2075, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Section of Dermatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.
- Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, 2 East Gates, Room 2075, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Hong GH, Khan IR, Shifera AS, Okeagu C, Thorne JE. Incidence and Clinical Characteristics of Ocular Involvement in Mucous Membrane Pemphigoid. Ocul Immunol Inflamm 2018; 27:821-825. [DOI: 10.1080/09273948.2018.1455879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Gloria H. Hong
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Irfan R. Khan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amde Selassie Shifera
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chinwenwa Okeagu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer E. Thorne
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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58
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Baglama Š, Trčko K, Rebol J, Miljković J. Oral manifestations of autoinflammatory and autoimmune diseases. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ma L, You C, Hernandez M, Maleki A, Lasave A, Schmidt A, Stephenson A, Zhao T, Anesi S, Foster CS. Management of Ocular Cicatricial Pemphigoid with Intravenous Immunoglobulin Monotherapy. Ocul Immunol Inflamm 2018. [DOI: 10.1080/09273948.2018.1433302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lina Ma
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Caiyun You
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mikhail Hernandez
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Andres Lasave
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Alexander Schmidt
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Andrew Stephenson
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Thongzen Zhao
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Stephen Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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60
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Yang A, Chin R, Murrell DF. Mucous membrane pemphigoid affecting the epiglottis and response to intravenous immunoglobulin therapy. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bagan J, Jiménez Y, Murillo J, Bagan L. Oral mucous membrane pemphigoid: A clinical study of 100 low-risk cases. Oral Dis 2018; 24:132-134. [DOI: 10.1111/odi.12744] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- J Bagan
- Head Service of Stomatology and Maxillofacial Surgery; University General Hospital; Fundación Hospital General Universitario; Valencia University; Valencia Spain
| | | | - J Murillo
- Head Section of Stomatology and Maxillofacial Surgery; University General Hospital; Valencia Spain
| | - L Bagan
- Universidad Europea de Valencia; Valencia Spain
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Kamaguchi M, Iwata H, Ujiie H, Izumi K, Natsuga K, Nishie W, Asaka T, Kitagawa Y, Shimizu H. Oral mucosa is a useful substrate for detecting autoantibodies of mucous membrane pemphigoid. Br J Dermatol 2018; 178:e119-e121. [DOI: 10.1111/bjd.15925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M. Kamaguchi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Iwata
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Ujiie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - K. Izumi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - K. Natsuga
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - W. Nishie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - T. Asaka
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - Y. Kitagawa
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
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63
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GONÇALO RIC, SEVERO MLB, MEDEIROS AMCD, OLIVEIRA PTD, SILVEIRA ÉJDD. Vesiculobullous autoimmune diseases with oral mucosa manifestations: retrospective and follow-up study. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/1981-863720180001000063368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To conduct a retrospective study on a series of cases of PV and BMMP with manifestations in the oral cavity in order to ascertain prevalence, sociodemographic characteristics, diagnostic maneuvers, treatment and follow-up. Methods: This is a retrospective, descriptive study in which clinical data were collected from the medical records of all cases of PV and BMMP registered and diagnosed, between 1995 and 2015, in the Oral Diagnostic Service of the UFRN Department of Dentistry. Results: The mean age of the total sample (n = 36) was 41.64, with females the most frequent (n = 26; 72.22%) and the cheek mucosa being the site most affected (n = 20; 27.40%). Eight patients (22.22%), including 5 cases of PV and 3 BMMP, were clinically reevaluated. All patients exhibited lesions at the time of follow-up. Prednisone (n=7; 87.5%) and clobetasol propionate (n=8, 100%) were the most widely used drugs in the systemic and topical treatment, respectively. The follow-up period ranged from 5 months to 5 years. Conclusion: The clinical profile of patients in this study was similar to that evidenced in the literature. However, it was found that the oral lesions were more resistant to the treatment used on the patients evaluated.
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64
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Saeed L, Schmidt TH, Gensler LS, Gross AJ, Fox LP, Scharschmidt TC, Gaensler K, Naik H, Rosenblum MA, Shinkai K. Successful treatment of mucous membrane pemphigoid with bortezomib. JAAD Case Rep 2017; 4:81-83. [PMID: 29387757 PMCID: PMC5771728 DOI: 10.1016/j.jdcr.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Lina Saeed
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Timothy H. Schmidt
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Lianne S. Gensler
- Division of Rheumatology, University of California San Francisco, San Francisco, California
| | - Andrew J. Gross
- Division of Rheumatology, University of California San Francisco, San Francisco, California
| | - Lindy P. Fox
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Tiffany C. Scharschmidt
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Karin Gaensler
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Haley Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Michael A. Rosenblum
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, San Francisco, California
- Correspondence to: Kanade Shinkai, MD, PhD, University of California, San Francisco, Department of Dermatology, 1701 Divisadero Street, 3rd floor, San Francisco, CA 94115.University of California, San FranciscoDepartment of Dermatology1701 Divisadero Street3rd floorSan FranciscoCA94115
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65
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Dharman S, Muthukrishnan A. Oral mucous membrane pemphigoid - Two case reports with varied clinical presentation. J Indian Soc Periodontol 2017; 20:630-634. [PMID: 29238145 PMCID: PMC5713088 DOI: 10.4103/jisp.jisp_155_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune chronic inflammatory, subepithelial blistering disorder, predominantly involving the mucous membranes. It has a female predilection and commonly occurring after the fifth decade of life. The oral mucosa is affected in more than 90% of cases. Dentists could be the first health personnel to identify and diagnose this rare mucocutaneous lesion. Two unique cases of oral MMP with varied clinical presentation, the diagnostic modality, treatment and follow-up are presented.
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Affiliation(s)
- Sreedevi Dharman
- Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Arvind Muthukrishnan
- Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
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Cizenski JD, Michel P, Watson IT, Frieder J, Wilder EG, Wright JM, Menter MA. Spectrum of orocutaneous disease associations: Immune-mediated conditions. J Am Acad Dermatol 2017; 77:795-806. [PMID: 29029901 DOI: 10.1016/j.jaad.2017.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
Abstract
There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.
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Affiliation(s)
- Jeffrey D Cizenski
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Pablo Michel
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Ian T Watson
- Texas A&M Health Science Center College of Medicine, Bryan, Texas
| | - Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Elizabeth G Wilder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - John M Wright
- Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, Texas
| | - M Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
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67
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Lambiel S, Dulguerov P, Laffitte E, Leuchter I. Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement. BMJ Case Rep 2017; 2017:bcr-2017-220887. [PMID: 28801511 PMCID: PMC5623279 DOI: 10.1136/bcr-2017-220887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 73-year-old woman was treated 8 years previously for synchronous breast and uterine neoplasms. She presented with a severe sore throat, odynophagia, dysphonia, dyspnoea, ocular irritation and weight loss over the last 3 months. Physical examination revealed ulcerations in the oral cavity, posterior pharyngeal wall and supraglottic larynx, nasal crusting, bilateral conjunctivitis and three cutaneous blisters. A diagnosis of anti-laminin 5 mucous membrane pemphigoid was retained, based on skin biopsy, direct immunofluorescence and immunoprecipitation. A positron emission tomography (PET)-CT detected multiple adenopathies. Cytology revealed adenocarcinoma with an immunocytology compatible with a breast origin and this was considered as a late metastatic recurrence of her previous breast cancer. A treatment of prednisone, dapsone and hormonotherapy was introduced, but intravenous immunoglobulin and rituximab were added due to new mucosal lesions. Despite treatment, a posterior laryngeal scar and bilateral symblepharon were developed. After 3 years, the patient is still alive and reports a satisfactory quality of life.
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Affiliation(s)
- Silvia Lambiel
- Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pavel Dulguerov
- Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Emmanuel Laffitte
- Département des Spécialités de Médecine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Igor Leuchter
- Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf 2017; 15:438-510. [PMID: 28736340 DOI: 10.1016/j.jtos.2017.05.011] [Citation(s) in RCA: 988] [Impact Index Per Article: 141.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022]
Abstract
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjögren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.
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Affiliation(s)
- Anthony J Bron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
| | - Cintia S de Paiva
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Eric E Gabison
- Department of Ophthalmology, Fondation Ophtalmologique Rothschild & Hôpital Bichat Claude Bernard, Paris, France
| | - Sandeep Jain
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Erich Knop
- Departments of Cell and Neurobiology and Ocular Surface Center Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Victor Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Driss Zoukhri
- Tufts University School of Dental Medicine, Boston, MA, USA
| | - David A Sullivan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Aounallah A, Jrad M, Ksiaa M, Mokni S, Saidi W, Boussofara L, Sriha B, Denguezli M, Ghariani N, Belajouza C, Nouira R. [A particular type of cicatricial Pemphigoid with unique IgA deposit]. Pan Afr Med J 2017; 26:136. [PMID: 28533859 PMCID: PMC5429461 DOI: 10.11604/pamj.2017.26.136.9702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 11/07/2016] [Indexed: 11/11/2022] Open
Abstract
Cicatricial Pemphigoid is a subepithelial bullous dermatosis which essentially involves the mucous membranes with cicatricial evolution We report the case of a 66-year old patient hospitalized with erosive gingivitis associated with dysphagia, dyspnea and blurred vision. Dermatologic examination showed erosive lesions involving the palate and the pharynx. Ophthalmologic examination showed symblepharons, ectropion and bilateral cataract. Gingival biopsy revealed a necrotic detachment of the buccal epithelium. Direct immunofluorescence showed linear IgA deposit at the dermo-epidermal junction. Indirect immunofluorescence test was negative. The diagnosis of cicatricial pemphigoid was confirmed. Esophagogastroduodenoscopy objectified double stenosis of the esophagus. Nasopharyngeal and bronchial endoscopy showed ulceration of the epiglottis, hypopharynx, pharynx and bronchial tree. The patient was treated with Solumedrol bolus corresponding to 0.5mg/kg/day prednisone associated with 100mg/day disulone. The patient showed a favorable early clinical outcome complicated because of the aggravation of dysphagia and esophageal stenosis after 2 months. Our case study is singular due to the occurrence of a cicatricial pemphigoid in a male patient with a serious clinical picture due to lesions extending to conjunctival, oral, nasal, esophageal and bronchial mucous membranes associated with direct immunofluorescence only showing IgA deposit.
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Affiliation(s)
- Amina Aounallah
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Mariem Jrad
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Mehdi Ksiaa
- Service de Gastroenterology Hospital Sahloul Sousse, Tunisie
| | - Sana Mokni
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Wafa Saidi
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Lobna Boussofara
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Badreddine Sriha
- Laboratoire d'Anathomopathlogie de l'Hôpital Farhat Hached Sousse, Tunisie
| | - Mohamed Denguezli
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Najet Ghariani
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Colandane Belajouza
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
| | - Rafia Nouira
- Université de Sousse, Tunisie.,Service de Dermatologie de l'Hôpital Farhat Hached de Sousse, Tunisie
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70
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Mendoza A, Rayhan D, Ji P. Mucous membrane pemphigoid with severe supraglottic stenosis and bilateral symblepharon. Pathology 2016; 49:95-97. [PMID: 27913046 DOI: 10.1016/j.pathol.2016.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 01/11/2023]
Affiliation(s)
| | - David Rayhan
- Harbor-UCLA Medical Center, Los Angeles, CA, United States
| | - Ping Ji
- Harbor-UCLA Medical Center, Los Angeles, CA, United States.
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71
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Kim M, Borradori L, Murrell DF. Autoimmune Blistering Diseases in the Elderly: Clinical Presentations and Management. Drugs Aging 2016; 33:711-723. [DOI: 10.1007/s40266-016-0402-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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72
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Tham HL, Olivry T, Linder KE, Bizikova P. Mucous membrane pemphigoid in dogs: a retrospective study of 16 new cases. Vet Dermatol 2016; 27:376-e94. [DOI: 10.1111/vde.12344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Heng L. Tham
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Thierry Olivry
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Keith E. Linder
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Department of Population Health and Pathobiology College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Petra Bizikova
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
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73
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Nash R, Hughes J, Kuchai R, Sandison A, Sandhu G. Assessment and management of laryngeal mucous membrane pemphigoid: our experience in six patients and a proposed severity scale. Clin Otolaryngol 2016; 42:752-756. [DOI: 10.1111/coa.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R. Nash
- Department of ENT; Charing Cross Hospital; London UK
| | - J. Hughes
- Department of ENT; Charing Cross Hospital; London UK
| | - R. Kuchai
- Department of ENT; Charing Cross Hospital; London UK
| | - A. Sandison
- Department of Histopathology; Charing Cross Hospital; London UK
| | - G. Sandhu
- Department of ENT; Charing Cross Hospital; London UK
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74
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Mair YH, Jhamb T, Visser MB, Aguirre A, Kramer JM. Sera and salivary matrix metalloproteinases are elevated in patients with vesiculoerosive disease: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:520-9. [PMID: 26948018 DOI: 10.1016/j.oooo.2016.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Oral vesiculoerosive (VE) diseases, such as lichen planus and mucous membrane pemphigoid, are immune-mediated pathoses. Matrix metalloproteinase (MMP)-2 and MMP-9 are elevated in oral lesional biopsy specimens of patients with VE disease. However, the systemic levels and activity of MMP-2 and MMP-9 in this patient population are poorly understood. We performed a pilot study to determine whether the levels and activity of MMP-2 and MMP-9 are elevated in the sera and saliva of patients with VE disease. STUDY DESIGN We recruited patients with VE disease (n = 10) and healthy controls (n = 19). We collected sera and saliva and performed enzyme-linked immunosorbent assays to measure MMP levels. We used gelatin zymography and Biotrak assays to determine enzyme activity. Data were analyzed using the Mann-Whitney test. RESULTS There was no difference in the activity of either MMP in the sera or saliva of patients with VE disease compared with controls. Significantly, MMP-2 levels were elevated in the sera of patients with VE disease (P < .0001), whereas MMP-9 was elevated in their saliva (P = .003). CONCLUSIONS MMP-2 is elevated in the sera of patients with VE disease, and MMP-9 is increased in their saliva. Therefore, these enzymes may be potential markers of disease or therapeutic targets.
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Affiliation(s)
- Yasmin H Mair
- Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Tania Jhamb
- Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, North-Shore LIJ Health System, Manhasset, NY, USA
| | - Michelle B Visser
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Alfredo Aguirre
- Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Jill M Kramer
- Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA; Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, North-Shore LIJ Health System, Manhasset, NY, USA; Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
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75
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Esophageal Cicatricial Pemphigoid as an Isolated Involvement Treated with Mycophenolate Mofetil. Case Rep Gastrointest Med 2015; 2015:620374. [PMID: 26557393 PMCID: PMC4628690 DOI: 10.1155/2015/620374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/27/2015] [Indexed: 11/18/2022] Open
Abstract
Cicatricial pemphigoid (CP) is a rare blistering autoimmune disease. Esophageal involvement occurs in widespread disease and rarely appears as the only affected organ. We report a 67-year-old Caucasian female with esophageal dysphagia and weight loss. Several oral panendoscopies showed multiple exudative ulcerations with fibrin and webs in mid- and proximal esophagus and a peeling mucosa. There were no lesions in other organs. We established the diagnosis performing a direct immunofluorescence (DIF), demonstrating IgG3 and complement deposition along the basement membrane. As initial treatment the patient received prednisone 60 mg and 1 gr twice daily of mycophenolate mofetil (MMF) as a steroid-sparing agent due to its lower toxicity and its selective mechanism of action. Six months later there was a significant clinical improvement and the esophageal ulcerations had disappeared, developing cicatricial fibrous rings, although no stenosis was present. Four years later, the patient remains asymptomatic with a low maintenance dose of MMF.
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76
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Taylor J, McMillan R, Shephard M, Setterfield J, Ahmed R, Carrozzo M, Grando S, Mignogna M, Kuten-Shorrer M, Musbah T, Elia A, McGowan R, Kerr A, Greenberg M, Hodgson T, Sirois D. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:161-71.e20. [DOI: 10.1016/j.oooo.2015.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 01/06/2023]
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77
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Affiliation(s)
- T Yap
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - M McCullough
- Melbourne Dental School; The University of Melbourne; Victoria Australia
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78
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de Freitas Silva BS, Silva Sant’Ana SS, Watanabe S, Vêncio EF, Roriz VM, Yamamoto-Silva FP. Multifocal red bands of the marginal gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:3-7. [DOI: 10.1016/j.oooo.2014.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/20/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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79
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Abstract
Oral mucosal diseases encompass several common conditions that affect the general population. Some of these disorders present with signs and symptoms that are pathognomonic for the condition, whereas others present with similar features that can make clinical diagnosis difficult to achieve. It is important for physicians to have a clear understanding of these disorders to provide appropriate care to patients. This article reviews clinical aspects of common oral mucosal disorders, including candidiasis, herpes simplex viral infections, aphthous stomatitis, lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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80
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Rabelo DF, Nguyen T, Caufield BA, Ahmed AR. Mucous membranepemphigoid in two half-sisters. The potential roles of autoantibodies to β4 integrin subunits and HLA-DQβ1*0301. J Dermatol Case Rep 2014; 8:9-12. [PMID: 24748904 DOI: 10.3315/jdcr.2014.1162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is a subepithelial autoimmune mucocutaneous disease. It most frequently affects the oral mucosa, followed by ocular and nasal mucosa, nasopharyngeal, anogenital, skin, laryngeal and esophageal mucosa. MAIN OBSERVATION Two half-sisters developed mucous membrane pemphigoid at approximately the same age. The older sister presented with primarily mucosal disease, while the younger had a more cutaneous disease. The histopathology demonstrated a subepithelial blister and direct immunofluorescence showed deposition of IgG and C3 at the basement membrane zone of perilesional tissues in both sisters. Antibodies to human β4 integrin were present in the sera of both patients and correlated with disease activity. Both sisters carried the same HLADQβ1* 0301 allele. CONCLUSIONS This is the first case of mucous membrane pemphigoid occurring in two half-sisters. Perhaps, it is the low incidence of mucous membrane pemphigoid that may account for the lack of reports on familial cases of the disease.
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Affiliation(s)
| | - Tegan Nguyen
- The Center for Blistering Diseases, Boston, MA, USA
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