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Izumi K, Nishie W, Mai Y, Wada M, Natsuga K, Ujiie H, Iwata H, Yamagami J, Shimizu H. Autoantibody Profile Differentiates between Inflammatory and Noninflammatory Bullous Pemphigoid. J Invest Dermatol 2016; 136:2201-2210. [PMID: 27424319 DOI: 10.1016/j.jid.2016.06.622] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/31/2016] [Accepted: 06/05/2016] [Indexed: 12/16/2022]
Abstract
Bullous pemphigoid (BP) is a major autoimmune blistering skin disorder, in which a majority of the autoantibodies (autoAbs) target the juxtamembranous extracellular noncollagenous 16A domain (NC16A) domain of hemidesmosomal collagen XVII. BP-autoAbs may target regions of collagen XVII other than the NC16A domain; however, correlations between epitopes of BP-autoAbs and clinical features have not been fully elucidated. To address correlations between the clinical features and specific epitopes of BP-autoAbs, we evaluated the epitope profiles of BP-autoAbs in 121 patients. A total of 87 patients showed a typical inflammatory phenotype with erythema and autoAbs targeting the anti-NC16A domain, whereas 14 patients showed a distinct noninflammatory phenotype, in which autoAbs specifically targeted the midportion of collagen XVII, but not NC16A. Interestingly, this group clinically showed significantly reduced erythema associated with scant lesional infiltration of eosinophils. Surprisingly, 7 of the 14 cases (50.0%) received dipeptidyl peptidase-IV inhibitors for the treatment of diabetes. Dipeptidyl peptidase-IV inhibitors were used in 3 of 76 (3.9%) typical cases of BP with autoAbs targeting NC16A; thus, dipeptidyl peptidase-IV inhibitors are thought to be involved in the development of atypical noninflammatory BP. This study shows that the autoAb profile differentiates between inflammatory and noninflammatory BP, and that noninflammatory BP may be associated with dipeptidyl peptidase-IV inhibitors.
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Affiliation(s)
- Kentaro Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Yosuke Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mayumi Wada
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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102
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Ren Z, Hsu D, Brieva J, Silverberg N, Langan S, Silverberg J. Hospitalization, inpatient burden and comorbidities associated with bullous pemphigoid in the U.S.A. Br J Dermatol 2016; 176:87-99. [DOI: 10.1111/bjd.14821] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Z. Ren
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
- The Graduate School Northwestern University Chicago IL 60611 U.S.A
| | - D.Y. Hsu
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - J. Brieva
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - N.B. Silverberg
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY U.S.A
| | - S.M. Langan
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London U.K
| | - J.I. Silverberg
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
- Departments of Preventive Medicine and Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
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103
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Lai Y, Yew Y, Lambert W. Bullous pemphigoid and its association with neurological diseases: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2016; 30:2007-2015. [DOI: 10.1111/jdv.13660] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/15/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Y.C. Lai
- Department of Dermatology; Rutgers New Jersey Medical School; Newark NJ USA
| | | | - W.C. Lambert
- Department of Dermatology; Rutgers New Jersey Medical School; Newark NJ USA
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104
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Lin Z, Si Q, Xiaoyi Z. Association between epilepsy and systemic autoimmune diseases: A meta-analysis. Seizure 2016; 41:160-6. [PMID: 27592469 DOI: 10.1016/j.seizure.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/29/2016] [Accepted: 08/12/2016] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the association between systemic autoimmune diseases (SAD) and epilepsy and to determine whether the strength of this association is increased in the young. METHODS A meta-analysis was done, analyzing the association between epilepsy and SAD using the available data in Medline and Embase through February 2016. We followed the recommendations of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and the MOOSE (meta-analysis of observational studies in epidemiology) guidelines. RESULTS A total of twenty-five studies met the inclusion criteria for this meta-analysis, which included 10,972 patients with epilepsy (PWE) and 2,618,637 patients with SAD. The PWE cohort was shown to have more than a 2.5-fold increased risk of SAD. The patients with SAD were also shown to have a more than 2.5-fold increased risk of epilepsy. The results indicated that patients <20 years of age had a 3-fold increased risk of SAD and epilepsy (OR=3.04 [95% CI 1.27-7.27], P=0.01; OR=3.15 [95% CI 1.92-5.15], P<0.01; respectively), and these risks were shown to be higher than patients >20 years of age. The PWE cohort had a 2.6-fold increased risk of celiac disease (OR=2.65 [95% CI 1.41-4.97], P<0.01). The patients with systemic lupus erythematosus had a 4.5-fold increased risk of epilepsy (OR=4.57 [95% CI 2.40-8.67], P<0.01). CONCLUSIONS There is an association between epilepsy and SAD, which was shown to be stronger at a young age.
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Affiliation(s)
- Zhang Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Si
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zou Xiaoyi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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105
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Nakane S, Izumi Y, Oda M, Kaji R, Matsuo H. A Potential Link between Amyotrophic Lateral Sclerosis and Bullous Pemphigoid: Six New Cases and a Systematic Review of the Literature. Intern Med 2016; 55:1985-90. [PMID: 27477403 DOI: 10.2169/internalmedicine.55.5578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Bullous pemphigoid in amyotrophic lateral sclerosis (BP-ALS) is rare and poorly understood. We herein assessed the association between ALS and BP using clinical and biological findings. Methods The clinical features of six new BP-ALS cases were described and collated with cases from a systematic literature review. Results Our six cases were combined with three other published cases. The mean disease duration (from ALS onset to the occurrence of BP) was 5.6±3.1 years. All patients had limb-onset ALS. Four of the 9 patients received riluzole, with the use of riluzole ranging from a few days to 3 years. When BP occurred, the status of the ALS patients was paretic and/or bedridden in all cases. BP occurred throughout the body, and we confirmed that the bullous lesions were located not only at the compression site, but also at the anterior part of the chest, abdomen, and limbs. Treatment for BP was successful, as oral prednisone and/or local corticosteroids were effective in 8 cases. Conclusion These six new cases, in combination with previous cases, expand our knowledge of the relationship between dermatological lesions and ALS. The pathogenesis of BP-ALS is poorly understood, however, some immunological aberrance is likely.
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Affiliation(s)
- Shunya Nakane
- Department of Neurology and Clinical Research, Nagasaki Kawatana Medical Center, Japan
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106
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Pietkiewicz P, Gornowicz-Porowska J, Bowszyc-Dmochowska M, Bartkiewicz P, Dmochowski M. Bullous pemphigoid and neurodegenerative diseases: a study in a setting of a Central European university dermatology department. Aging Clin Exp Res 2016; 28:659-63. [PMID: 26420424 PMCID: PMC4930474 DOI: 10.1007/s40520-015-0459-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/18/2015] [Indexed: 01/10/2023]
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering dermatosis of the elderly mediated by IgG and IgE antibodies to skin hemidesmosomal proteins, BP180 and/or BP230, that occur physiologically also in neuronal tissue. It was reported that BP is associated with neurodegenerative diseases (ND). We performed a retrospective study in a setting of a Central European university dermatology department on prevalence of ND in 94 BP patients. 26 out of 94 BP patients had at least one ND. ND included: Parkinson's disease, dementia, stroke, hear loss, tinnitus, blindness, vertigo, neurosyphilis, systemic sclerosis, and epilepsy. Since population aging is conceivably responsible for the rising number of BP cases as a result of immunosenescence-related phenomena, the plausible BP-specific immunopathogenetic relationship between BP and ND deserves to be further experimentally explored.
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Affiliation(s)
- Paweł Pietkiewicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland.
| | - Justyna Gornowicz-Porowska
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Cutaneous Histopathology and Immunopathology Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Bartkiewicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
| | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
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107
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Recke A, Oei A, Hübner F, Fechner K, Graf J, Hagenah J, May C, Woitalla D, Salmen A, Zillikens D, Gold R, Schlumberger W, Schmidt E. Parkinson disease and multiple sclerosis are not associated with autoantibodies against structural proteins of the dermal-epidermal junction. Br J Dermatol 2016; 175:407-9. [PMID: 26972435 DOI: 10.1111/bjd.14538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Recke
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - A Oei
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - F Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - K Fechner
- Institute of Experimental Immunology, Euroimmun Inc., Lübeck, Germany
| | - J Graf
- Departments of Neurology, University of Lübeck, Lübeck, Germany
| | - J Hagenah
- Departments of Neurology, University of Lübeck, Lübeck, Germany
| | - C May
- Medizinisches Proteom-Center, Ruhr-Universität Bochum, Bochum, Germany
| | - D Woitalla
- Department of Neurology, Katholische Kliniken Ruhrhalbinsel GmbH, Essen, Germany
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - R Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - W Schlumberger
- Institute of Experimental Immunology, Euroimmun Inc., Lübeck, Germany
| | - E Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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108
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Schmidt E, Goebeler M, Hertl M, Sárdy M, Sitaru C, Eming R, Hofmann SC, Hunzelmann N, Kern JS, Kramer H, Orzechowski HD, Pfeiffer C, Schuster V, Sporbeck B, Sticherling M, Worm M, Zillikens D, Nast A. S2k guideline for the diagnosis of pemphigus vulgaris/foliaceus and bullous pemphigoid. J Dtsch Dermatol Ges 2016; 13:713-27. [PMID: 26110729 DOI: 10.1111/ddg.12612] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Enno Schmidt
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Miklós Sárdy
- Department of Dermatology, Venereology, and Allergology, University Hospital Munich (LMU), Munich, Germany
| | - Cassian Sitaru
- Department of Dermatology and Venereology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology, and Dermatosurgery, Helios Hospital Wuppertal, Wuppertal, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Johannes S Kern
- Department of Dermatology and Venereology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | | | - Hans-Dieter Orzechowski
- Institute of Clinical Pharmacology and Toxicology, Charité - University Hospital Berlin, Berlin, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
| | - Volker Schuster
- Pediatric Immunology and Rheumatology, University Hospital and Outpatient Clinical for Children and Adolescents, Leipzig, Germany
| | - Birte Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
| | | | - Margitta Worm
- Center for Allergy, Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Alexander Nast
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
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Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
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Affiliation(s)
| | | | - Sylvia Hsu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Kass
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St., 9th Floor, Houston, TX, 77030, USA.
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Messingham KAN, Aust S, Helfenberger J, Parker KL, Schultz S, McKillip J, Narayanan NS, Fairley JA. Autoantibodies to Collagen XVII Are Present in Parkinson's Disease and Localize to Tyrosine-Hydroxylase Positive Neurons. J Invest Dermatol 2016; 136:721-723. [PMID: 27015458 PMCID: PMC4809024 DOI: 10.1016/j.jid.2015.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022]
Affiliation(s)
| | - Samantha Aust
- Department of Dermatology, University of Iowa, Iowa City, IA
| | | | - Krystal L Parker
- Department of Neurology and Aging Mind and Brain Initiative, University of Iowa, Iowa City, IA
| | - Susan Schultz
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Julie McKillip
- Department of Dermatology, University of Iowa, Iowa City, IA
| | - Nandakumar S Narayanan
- Department of Neurology and Aging Mind and Brain Initiative, University of Iowa, Iowa City, IA
| | - Janet A Fairley
- Department of Dermatology, University of Iowa, Iowa City, IA; Veterans Administration Medical Center, Iowa City, IA.
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111
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Hammers CM, Stanley JR. Mechanisms of Disease: Pemphigus and Bullous Pemphigoid. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2016; 11:175-97. [PMID: 26907530 DOI: 10.1146/annurev-pathol-012615-044313] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pemphigus and bullous pemphigoid are autoantibody-mediated blistering skin diseases. In pemphigus, keratinocytes in epidermis and mucous membranes lose cell-cell adhesion, and in pemphigoid, the basal keratinocytes lose adhesion to the basement membrane. Pemphigus lesions are mediated directly by the autoantibodies, whereas the autoantibodies in pemphigoid fix complement and mediate inflammation. In both diseases, the autoantigens have been cloned and characterized; pemphigus antigens are desmogleins (cell adhesion molecules in desmosomes), and pemphigoid antigens are found in hemidesmosomes (which mediate adhesion to the basement membrane). This knowledge has enabled diagnostic testing for these diseases by enzyme-linked immunosorbent assays and dissection of various pathophysiological mechanisms, including direct inhibition of cell adhesion, antibody-induced internalization of antigen, and cell signaling. Understanding these mechanisms of disease has led to rational targeted therapeutic strategies.
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Affiliation(s)
- Christoph M Hammers
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 19104; .,Department of Dermatology, University of Luebeck, D-23562 Luebeck, Germany;
| | - John R Stanley
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
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112
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Chevalier V, Barbe C, Reguiai Z, Plée J, Grange F, Bernard P. [Impact of neurological diseases on the prognosis of bullous pemphigoid: A retrospective study of 178 patients]. Ann Dermatol Venereol 2016; 143:179-86. [PMID: 26831943 DOI: 10.1016/j.annder.2015.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/23/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) mainly affects elderly patients. It is often associated with neurological disorders, which constitute a major risk factor of the disease. The aim of our study was to determine whether neurological disorders, particularly dementia, influence outcome and mortality in BP patients. PATIENTS AND METHODS We conducted a retrospective study of all patients with BP seen in our dermatology department consecutively between 1997 and 2011. Clinical, immunological and therapeutic data, number of relapses and survival status were compared according to the presence at diagnosis of neurological disorders, particularly dementia. RESULTS Among the 178 patients included, an associated neurological disease was present in 84 (47.2%) and dementia in 43 (24.2%) at the time of diagnosis of BP. Patients with associated dementia were older and had a lower Karnofsky index. Sixty-four patients (37.8%) had had at least one clinical relapse of BP, chiefly within the first 18 months after starting therapy. Coexistent neurological disease was not associated with BP relapse (P=0.55) contrary to an extensive BP phenotype at diagnosis (P=0.008). Coexistent neurological disease and/or dementia were associated with higher mortality (P=0.03 and P<0.001, respectively), but did not modify the type or the total duration of BP treatment. CONCLUSION A coexistent neurological disease or dementia at the time of diagnosis of BP significantly increase the risk of mortality and shortens the duration of clinical follow-up of patients with BP, thus limiting the analysis of their influence on the outcome of BP itself.
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Affiliation(s)
- V Chevalier
- Service de dermatologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - C Barbe
- Département de recherche clinique, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Z Reguiai
- Service de dermatologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - J Plée
- Service de dermatologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - F Grange
- Service de dermatologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - P Bernard
- Service de dermatologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
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113
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Künzli K, Favre B, Chofflon M, Borradori L. One gene but different proteins and diseases: the complexity of dystonin and bullous pemphigoid antigen 1. Exp Dermatol 2015; 25:10-6. [DOI: 10.1111/exd.12877] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Kseniia Künzli
- Department of Dermatology; Inselspital; Bern University Hospital; Bern Switzerland
| | - Bertrand Favre
- Department of Dermatology; Inselspital; Bern University Hospital; Bern Switzerland
| | - Michel Chofflon
- Department of Clinical Neurosciences; Geneva University Hospitals; Geneva Switzerland
| | - Luca Borradori
- Department of Dermatology; Inselspital; Bern University Hospital; Bern Switzerland
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114
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Oh D, Zhao C, Murrell D. A review of case-control studies on the risk factors for the development of autoimmune blistering diseases. J Eur Acad Dermatol Venereol 2015; 30:595-603. [DOI: 10.1111/jdv.13386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/07/2015] [Indexed: 01/21/2023]
Affiliation(s)
- D.D. Oh
- Department of Dermatology; St George Hospital; Sydney NSW Australia
- University of New South Wales; Sydney NSW Australia
| | - C.Y. Zhao
- Department of Dermatology; St George Hospital; Sydney NSW Australia
- University of New South Wales; Sydney NSW Australia
| | - D.F. Murrell
- Department of Dermatology; St George Hospital; Sydney NSW Australia
- University of New South Wales; Sydney NSW Australia
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115
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Schmidt E, Goebeler M, Hertl M, Sárdy M, Sitaru C, Eming R, Hofmann SC, Hunzelmann N, Kern JS, Kramer H, Orzechowski HD, Pfeiffer C, Schuster V, Sporbeck B, Sticherling M, Worm M, Zillikens D, Nast A. S2k-Leitlinie zur Diagnostik des Pemphigus vulgaris/foliaceus und des bullösen Pemphigoids. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.40_12612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Enno Schmidt
- Klinik für Dermatologie; Allergologie und Venerologie, Universität Lübeck; Lübeck
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg; Würzburg
| | - Michael Hertl
- Klinik für Dermatologie und Allergology Universitätsklinikum Marburg
| | - Miklós Sárdy
- Klinik und Poliklinik für Dermatologie und Allergologie; Klinikum der Universität München (LMU); München
| | - Cassian Sitaru
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg; Albert-Ludwigs-Universität Freiburg; Freiburg
| | - Rüdiger Eming
- Klinik für Dermatologie und Allergology Universitätsklinikum Marburg
| | - Silke C. Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie; Helios Klinikum Wuppertal
| | - Nicolas Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie; Universität zu Köln
| | - Johannes S. Kern
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg; Albert-Ludwigs-Universität Freiburg; Freiburg
| | | | | | | | - Volker Schuster
- Pädiatrische Immunologie und Rheumatologie; Universitätsklinik und Poliklinik für Kinder und Jugendliche; Leipzig
| | - Birte Sporbeck
- Division of Evidence Based Medicine (dEBM); Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
| | | | - Margitta Worm
- Allergie-Centrum, Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
| | - Detlef Zillikens
- Klinik für Dermatologie; Allergologie und Venerologie, Universität Lübeck; Lübeck
| | - Alexander Nast
- Division of Evidence Based Medicine (dEBM); Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
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Regulation of the Neurodegenerative Process Associated to Parkinson's Disease by CD4+ T-cells. J Neuroimmune Pharmacol 2015; 10:561-75. [PMID: 26018603 DOI: 10.1007/s11481-015-9618-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/19/2015] [Indexed: 01/09/2023]
Abstract
Neuroinflammation constitutes a fundamental process involved in the physiopathology of Parkinson's disease (PD). Microglial cells play a central role in the outcome of neuroinflammation and consequent neurodegeneration of dopaminergic neurons in the substantia nigra. Current evidence indicates that CD4+ T-cells infiltrate the central nervous system (CNS) in PD, where they play a critical role determining the functional phenotype of microglia, thus regulating the progression of the neurodegenerative process. Here, we first analysed the pathogenic role of inflammatory phenotypes and the beneficial role of anti-inflammatory phenotypes of encephalitogenic CD4+ T-cells involved in the physiopathology of PD. Next, we discussed how alterations of neurotransmitter levels observed in the basal ganglia throughout the time course of PD progression could be strongly affecting the behaviour of encephalitogenic CD4+ T-cells and thereby the outcome of the neuroinflammatory process and the consequent neurodegeneration of dopaminergic neurons. Afterward, we integrated the evidence indicating the involvement of an antigen-specific immune response mediated by T-cells and B-cells against CNS-derived self-constituents in PD. Consistent with the involvement of a relevant autoimmune component in PD, we also reviewed the polymorphisms of both, class I and class II major histocompatibility complexes, associated to the risk of PD. Overall, this study gives an overview of how an autoimmune component involved in PD plays a fundamental role in the progression of the neurodegenerative process.
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Phoon YW, Fook-Chong SM, Koh HY, Thirumoorthy T, Pang SM, Lee HY. Infectious complications in bullous pemphigoid: An analysis of risk factors. J Am Acad Dermatol 2015; 72:834-9. [DOI: 10.1016/j.jaad.2015.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
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Gurel MS, Savas S, Bilgin F, Erdil D, Leblebici C, Sarikaya E. Zosteriform pemphigoid after zoster: Wolf's isotopic response. Int Wound J 2015; 13:141-2. [PMID: 25659195 DOI: 10.1111/iwj.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/11/2015] [Indexed: 11/30/2022] Open
Abstract
The Wolf isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed disease. The most common primary skin disorder of this phenomenon is herpes zoster and less frequently, herpes simplex. We report a case of 79-year-old woman who have bullous pemphigoid (BP) with dermatomal distribution that developed at the site of previously healed herpes zoster. Based on clinical, histological and immunofluorescence findings, the patient was diagnosed with localized BP in a site of prior herpes zoster. BP developing at the site of healed herpes zoster is the first reported case. Recognition of this phenomenon is important for correct clinicopathologic diagnosis and may improve our understanding of the underlying pathophysiologic processes.
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Affiliation(s)
- Mehmet S Gurel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sevil Savas
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Fusun Bilgin
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ebru Sarikaya
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
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Gambichler T, Segert H, Höxtermann S, Schmitz L, Altmeyer P, Teegen B. Neurological disorders in patients with bullous pemphigoid: clinical and experimental investigations. J Eur Acad Dermatol Venereol 2015; 29:1758-62. [PMID: 25651418 DOI: 10.1111/jdv.12995] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/07/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous studies have shown that patients with bullous pemphigoid (BP) are more likely to have neurological diseases (ND). OBJECTIVES To compare clinical findings in BP patients with and without ND and to investigate BP180 autoantibody binding in different neuronal tissues of mammalians. METHODS Our database was searched for clinical findings of in-patients with the definitive diagnosis of BP. Moreover, brain tissue of mammalians was treated with serum of BP patients with elevated BP180 autoantibodies using biochip mosaics. RESULTS Of 85/161 (52.8%) patients had a history of at least one ND (BP+ND). BP180 (P = 0.018), eosinophils (P = 0.043) and patients' accommodation in nursing homes (P < 0.0001) remained in the logistic regression model as significant independent predictors for the presence of ND in patients with BP. Subgroup analysis of community-dwelling BP patients revealed 25/93 (26.9%) patients with ND. In this population, the presence of ND also significantly correlated with BP180 (r = 0.26; P = 0.0003) and eosinophils (r = 0.19; P = 0.0087). In the animal model, no BP180-specific immunofluorescence could be detected. CONCLUSIONS Our data support results of previous studies detecting significantly increased frequency of ND in BP patients. We have shown that raised BP180 titres and blood eosinophils are independent predictors for the presence of ND in BP patients. However, our experimental data do not support previous results indicating that specific binding of BP180 antibodies in neuronal tissue plays a pathogenetic role in ND.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H Segert
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Höxtermann
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - P Altmeyer
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - B Teegen
- Institute for Experimental Immunology, Euroimmun, Lübeck, Germany
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Turcan I, Jonkman MF. Blistering disease: insight from the hemidesmosome and other components of the dermal-epidermal junction. Cell Tissue Res 2014; 360:545-69. [PMID: 25502077 DOI: 10.1007/s00441-014-2021-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/25/2014] [Indexed: 02/07/2023]
Abstract
The hemidesmosome is a specialized transmembrane complex that mediates the binding of epithelial cells to the underlying basement membrane. In the skin, this multiprotein structure can be regarded as the chief adhesion unit at the site of the dermal-epidermal junction. Focal adhesions are additional specialized attachment structures located between hemidesmosomes. The integrity of the skin relies on well-assembled and functional hemidesmosomes and focal adhesions (also known as integrin adhesomes). However, if these adhesion structures are impaired, e.g., as a result of circulating autoantibodies or inherited genetic mutations, the mechanical strength of the skin is compromised, leading to blistering and/or tissue inflammation. A particular clinical presentation emerges subject to the molecule that is targeted. None of these junctional complexes are simply compounds of adhesion molecules; they also play a significant role in signalling pathways involved in the differentiation and migration of epithelial cells such as during wound healing and in tumour invasion. We summarize current knowledge about hereditary and acquired blistering diseases emerging from pathologies of the hemidesmosome and its neighbouring proteins as components of the dermal-epidermal junction.
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Affiliation(s)
- Iana Turcan
- Centre for Blistering Diseases, Department of Dermatology, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands,
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Behlim T, Sharma YK, Chaudhari ND, Dash K. Dyshidrosiform pemphigoid with Parkinsonism in a nonagenarian Maharashtrian female. Indian Dermatol Online J 2014; 5:482-4. [PMID: 25396135 PMCID: PMC4228647 DOI: 10.4103/2229-5178.142509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Dyshidrosiform pemphigoid is a rare variant of bullous pemphigoid localized to the hands and feet whose characteristic subepidermal blisters develop as a result of binding of the IgG autoantibodies to intracellular plaque and extracellular face of the hemidesmosome recognizing a 230-kDa plakin molecule (BP230, BPAg1or BPAg1e) and a 180-kDa transmembrane protein. Neurodegenerative processes (viz., stroke, dementia, Parkinsonism, epilepsy, etc) uncover BPAg1-n, an alternatively spliced form of BPAg1-e that stabilizes the cytoskeleton of sensory neurons, generating autoantibodies that may subsequently lead to BP by cross-reacting with BPAg1-e. We present a patient with Parkinsonism who later developed blisters, erosions and crusts localized to the palms and soles, confirmed histopathologically as bullous pemphigoid. To the best of our knowledge, ours is the first case report from India wherein Parkinsonism-generated autoantibodies led to the development of dyshidrosiform pemphigoid due to their cross-reactivity with BPAg1-e.
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Affiliation(s)
- Tabassum Behlim
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
| | - Yugal K Sharma
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
| | - Nitin D Chaudhari
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
| | - Kedarnath Dash
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
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Association Between Bullous Pemphigoid and Neurologic Diseases: A Case-Control Study. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Casas-de-la-Asunción E, Ruano-Ruiz J, Rodríguez-Martín A, Vélez García-Nieto A, Moreno-Giménez J. Asociación de penfigoide y enfermedad neurológica: estudio de casos y controles. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:860-5. [DOI: 10.1016/j.ad.2014.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/15/2014] [Accepted: 04/21/2014] [Indexed: 12/16/2022] Open
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Teixeira VB, Cabral R, Brites MM, Vieira R, Figueiredo A. Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients. An Bras Dermatol 2014; 89:274-8. [PMID: 24770504 PMCID: PMC4008058 DOI: 10.1590/abd1806-4841.20142516] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/06/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND aAlthough rare, bullous pemphigoid (BP) is the most common autoimmune blistering
disease. Recent studies have shown that patients with bullous pemphigoid are more
likely to have neurological and psychiatric diseases, particularly prior to the
diagnosis of bullous pemphigoid. OBJECTIVE The aims were: (i) to evaluate the demographic and clinical features of bullous
pemphigoid from a database of patients at a Portuguese university hospital and
(ii) to compare the prevalence of comorbid conditions before the diagnosis of
bullous pemphigoid with a control group. METHODS Seventy-seven patients with bullous pemphigoid were enrolled in the study. They
were compared with 176 age- and gender-matched controls, which also had the same
inpatient to outpatient ratio, but no history of bullous or cutaneous malignant
disease. Univariate and multivariate analyses were used to calculate odds ratios
for specific comorbid diseases. RESULTS At least one neurologic diagnosis was present in 55.8% of BP patients compared
with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in
35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25
(2.71-10.16); and Parkinson's disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using
multivariate analysis, all diseases except Parkinson's retained their association
with BP. Patients under systemic treatment were eight times more likely to have
complications than those treated with topical steroids (p< 0.017). CONCLUSIONS The results of this study substantiate the association between BP and neurological
diseases. In addition, they highlight the potential complications associated with
the treatment of BP.
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Brick KE, Weaver CH, Savica R, Lohse CM, Pittelkow MR, Boeve BF, Gibson LE, Camilleri MJ, Wieland CN. A population-based study of the association between bullous pemphigoid and neurologic disorders. J Am Acad Dermatol 2014; 71:1191-7. [PMID: 25174542 DOI: 10.1016/j.jaad.2014.07.052] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) has been associated with neurologic disorders. OBJECTIVE We sought to analyze the association between BP and neurologic disorders. METHODS We retrospectively identified residents of Olmsted County, Minnesota, with a first lifetime diagnosis of BP between January 1, 1960, and December 31, 2009. Three age- and sex-matched Olmsted County, Minnesota, residents without BP were selected as control subjects for each patient. We compared history of or development of neurologic disorders (dementia, Alzheimer disease, Parkinson disease, multiple sclerosis, cerebrovascular disease, and seizures) between groups using case-control and cohort designs. RESULTS In all, 87 patients with BP were identified and matched to 261 control subjects. The odds of a previous diagnosis of any neurologic disorder or a history of dementia were significantly increased among cases compared with controls (odds ratio 6.85; 95% confidence interval [CI] 3.00-15.64; P < .001; and odds ratio 6.75; 95% CI 2.08-21.92; P = .002, respectively). Both Parkinson disease (hazard ratio 8.56; 95% CI 1.55-47.25; P = .01) and any type of neurologic disorder (hazard ratio 2.02; 95% CI 1.17-3.49; P = .01) were significantly more likely to develop during follow-up in patients with than without BP. LIMITATIONS Small geographic area and retrospective study design are limitations. CONCLUSION Findings confirmed an association of BP with neurologic disorders, especially dementia and Parkinson disease.
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Affiliation(s)
| | - Chad H Weaver
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Rodolfo Savica
- Department of Neurology, Division of Sleep and Movement Disorders, University of Utah, Salt Lake City, Utah
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Camilleri
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
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Schmidt T, Sitaru C, Amber K, Hertl M. BP180- and BP230-specific IgG autoantibodies in pruritic disorders of the elderly: a preclinical stage of bullous pemphigoid? Br J Dermatol 2014; 171:212-9. [PMID: 24601973 DOI: 10.1111/bjd.12936] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 12/22/2022]
Abstract
Pruritus increasingly occurs in the elderly population and is associated with a variety of dermatoses of mixed aetiology. Clinical and experimental evidence suggests that senile pruritus may be linked to autoimmune events initiated by loss of self-tolerance against cutaneous autoantigens, which is facilitated by immune ageing processes. T-cell immunity, which underpins the production of pathogenic autoantibodies in autoimmune diseases, is deregulated by immune senescence thereby leading to autoimmune disorders such as bullous pemphigoid (BP). High mortality rates of BP combined with steadily increasing incidence emphasize the need for an effective diagnostic strategy at an early stage. We summarize here the current understanding of immunological alterations during the ageing process, thereby focusing on aberrant T-cell responses against the basement membrane antigens BP180 and BP230, which may eventually lead to the clinical outcome of BP.
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Affiliation(s)
- T Schmidt
- Department of Dermatology and Allergology, Philipps University, Baldinger Str., D-35043, Marburg, Germany
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128
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Abstract
Lupus erythematosus (LE) is a chronic, autoimmune, multisystem disease that displays many diverse symptoms in which localized cutaneous LE (CLE) is on one end of the spectrum and severe systemic LE (SLE) on the other end. The underlying cause of LE is unknown but the etiology is thought to be multifactorial and polygenic. CLE is a disfiguring, chronic skin disease, with a significant impact on the patients’ everyday life. CLE are further divided into three main subsets: Acute CLE (ACLE), subacute CLE (SCLE) and chronic CLE (CCLE), where classic discoid LE (DLE) is the most common form. These subsets are defined by clinical symptoms, average duration of symptoms and histological and serological findings, although, the three subtypes can have overlapping clinical features. CLE patients display well-defined skin lesions, often in sun-exposed areas. The disease often has a chronic and relapsing course that can be induced or aggravated by UV light. It is important to confirm a CLE diagnosis histopathologically by a biopsy and in that there are several differential diagnoses and because CLE is a chronic disease in which regular follow-up is important and systemic treatment is sometimes indicated.
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Affiliation(s)
- Carina M Grönhagen
- Institute of Environmental Medicine, Unit of Occupational and Environmental Dermatology, Karolinska Institutet, Stockholm, Sweden
| | - Filippa Nyberg
- Uppsala University Hospital, Department of Dermatology, Uppsala, Sweden
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129
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Napthali K, Boyle M, Tran H, Schofield PW, Peel R, McEvoy M, Oldmeadow C, Attia J. Thyroid antibodies, autoimmunity and cognitive decline: is there a population-based link? Dement Geriatr Cogn Dis Extra 2014; 4:140-6. [PMID: 24987403 PMCID: PMC4067731 DOI: 10.1159/000362716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Autoimmunity is considered an uncommon but under-recognised cause of cognitive decline. METHODS Serum samples from 3,253 randomly selected subjects enrolled in the Hunter Community Study, aged 55-85 years, were assayed for thyrotropin stimulatory hormone, anti-thyroid peroxidase antibodies (TPO-Ab), anti-nuclear antibodies (ANA) and extractable nuclear antigens (ENA). Cognitive function was assessed using the Audio Recorded Cognitive Screen (ARCS) tool. RESULTS TPO-Ab were found in 8.4% and ANA in 27.9% of the study population, of whom 3% had positive ENA findings. No relationship was found between the ARCS score and either TPO-Ab (coefficient = 0.133; 95% CI -0.20, 0.82, p = 0.616), ANA at a low (coefficient = 1.01; 95% CI -2.58, 0.55, p = 0.203) or a high titre (coefficient = -0.65; 95% CI -2.59, 1.28, p = 0.508), or ENA antibodies (coefficient = 5.12; 95% CI -0.53, 10.77; p = 0.076). CONCLUSIONS Autoantibody findings are common in an aging population and are not associated with cognitive decline.
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Affiliation(s)
- Kate Napthali
- Division of Medicine, John Hunter Hospital, University of Newcastle, Newcastle, N.S.W., Australia
| | - Michael Boyle
- Division of Medicine, John Hunter Hospital, University of Newcastle, Newcastle, N.S.W., Australia
| | - Huy Tran
- Hunter Area Pathology Service, Newcastle, N.S.W., Australia
| | - Peter W Schofield
- Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, N.S.W., Australia ; Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia ; Neuropsychiatry Unit, Hunter New England Local Health District, Newcastle, N.S.W., Australia
| | - Roseanne Peel
- Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia ; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, N.S.W., Australia
| | - Mark McEvoy
- Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia ; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, N.S.W., Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia ; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, N.S.W., Australia
| | - John Attia
- Division of Medicine, John Hunter Hospital, University of Newcastle, Newcastle, N.S.W., Australia ; Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia ; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, N.S.W., Australia
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130
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Vassileva S, Drenovska K, Manuelyan K. Autoimmune blistering dermatoses as systemic diseases. Clin Dermatol 2014; 32:364-75. [DOI: 10.1016/j.clindermatol.2013.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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131
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Cai SCS, Allen JC, Lim YL, Chua SH, Tan SH, Tang MBY. Mortality of bullous pemphigoid in Singapore: risk factors and causes of death in 359 patients seen at the National Skin Centre. Br J Dermatol 2014; 170:1319-26. [PMID: 24372558 DOI: 10.1111/bjd.12806] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common autoimmune-mediated subepidermal blistering skin disease and is associated with significant morbidity and mortality. OBJECTIVES To determine the 3-year mortality rate, risk factors and causes of death in patients with BP in Singapore, compared with the general population. METHODS We conducted a retrospective cohort study of all newly diagnosed patients with BP seen at the National Skin Centre from 1 April 2004 to 31 December 2009. Demographic and clinical data on comorbidities and treatment were recorded. Mortality information was obtained from the National Registry of Diseases. RESULTS In total 359 patients were included in our study. The 1-, 2-, 3-year mortality rates were 26·7%, 38·4% and 45·7%, respectively. The 3-year standardized mortality risk for patients with BP was 2·74 (95% confidence interval 2·34-3·19) times higher than for the age- and sex-matched general population. Parkinson disease, heart failure and chronic renal disease were associated with increased mortality, while combination treatment with low-to-moderate-dose corticoste-roids and immunomodulatory agents such as doxycycline and/or nicotinamide was associated with lower mortality. Overall, infections were the most common cause of death (59·8%), with the main causes of death being pneumonia (42·7%), cardiovascular disease (14·6%) and stroke (11·6%). CONCLUSIONS This study confirms an increased 3-year mortality rate for patients with BP in Singapore. Risk factors for increased mortality include medical comorbidities, especially neurological, cardiac and renal diseases. Treatment with combination therapy, including the use of low-to-moderate-dose corticosteroid, appeared to decrease mortality risk in patients with BP.
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Affiliation(s)
- S C S Cai
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
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Massa AF, Varela P, Osório-Ferreira E, Nora M, Couceiro A, Baptista A. Bullous pemphigoid in a patient with multiple sclerosis being treated with human immunoglobulin. J Eur Acad Dermatol Venereol 2014; 29:821-2. [PMID: 24588974 DOI: 10.1111/jdv.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A F Massa
- Department of Dermatology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
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133
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Les maladies bulleuses auto-immunes. Rev Med Interne 2014; 35:166-73. [DOI: 10.1016/j.revmed.2013.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
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Nishie W. Update on the pathogenesis of bullous pemphigoid: an autoantibody-mediated blistering disease targeting collagen XVII. J Dermatol Sci 2014; 73:179-86. [PMID: 24434029 DOI: 10.1016/j.jdermsci.2013.12.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/04/2013] [Indexed: 12/29/2022]
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering skin disorder that tends to affect the elderly. Autoantibodies (autoAbs) from BP patients react with two hemidesmosomal components: transmembrane collagen XVII (BP180 or BPAG2) and plakin family protein BP230 (BPAG1). Of these, collagen XVII (COL17) is thought to be a major autoantigen. The binding of autoAbs to COL17 following the activation of complements and inflammatory pathways eventually leads to the degradation of COL17, and this has been regarded as the main pathogenesis of BP. However, recent investigations have suggested other pathways, including a complement-independent pathway and a pathway involving IgE-autoAbs. BP-autoAbs can directly deplete COL17, leading to fragility of the dermal-epidermal junction. In addition, IgE-autoAbs to COL17 may be involved in the formation of itchy urticarial erythema associated with eosinophilic infiltration. This article summarizes the update on pathogenesis of BP, with a special focus on blister formation by autoAbs to COL17.
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Affiliation(s)
- Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Stavropoulos PG, Soura E, Antoniou C. Drug-induced pemphigoid: a review of the literature. J Eur Acad Dermatol Venereol 2014; 28:1133-40. [PMID: 24404939 DOI: 10.1111/jdv.12366] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/11/2013] [Indexed: 01/03/2023]
Abstract
Bullous pemphigoid is an acquired autoimmune disease that is characterized by subepidermal blistering and affects mainly the elderly. The pathogenesis of the condition has not yet been fully elucidated, but it is widely accepted that a strong correlation with various medications may exist. In reality, more than 50 different drugs have been associated with the appearance of bullous pemphigoid and as new therapies emerge, this number is very likely to increase. A number of pathogenetic mechanisms have been proposed in the past. It is true that a delicate immunological balance is disturbed in all patients with the disease. The variable effects that may be exhibited by the use of biological drugs could shed some light in this complex immunological behaviour. At the same time, drug-induced bullous pemphigoid is difficult to differentially diagnose from its idiopathic counterpart, as the clinical picture and histopathological findings in both conditions may only have subtle differences. Patients who present with bullous pemphigoid and receive multiple regimens should always be suspected of suffering from the drug-induced variant of the condition. This possibility must be considered, as after the withdrawal of the suspect medication most patients respond rapidly to treatment and do not experience relapses.
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Affiliation(s)
- P G Stavropoulos
- 1st Department of Dermatology/University Clinic, "Andreas Sygros" Hospital, Athens, Greece
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136
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Barrick BJ, Lohse CM, Lehman JS. Specific causes of death in patients with bullous pemphigoid as measured by death certificate data: a retrospective cohort study. Int J Dermatol 2013; 54:56-61. [PMID: 24372100 DOI: 10.1111/ijd.12243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mortality rates in patients with bullous pemphigoid (BP) are higher than those in age-matched counterparts. However, the specific causes of death in BP subjects have not been evaluated systematically. OBJECTIVES We sought to characterize the causes of death in patients with BP as recorded by death certificate and to compare these with death data for age- and location-matched control subjects. METHODS This was a retrospective cohort analysis conducted in a large tertiary referral center. Twenty-seven participants who had a confirmed antemortem diagnosis of BP, were residents of Olmsted County, Minnesota, and had died between January 1, 1999, and January 1, 2009, were included in the study. Underlying cause of death and multiple causes of death data for the study population were compared with data sourced from the Centers for Disease Control and Prevention (CDC) for a control group matched by age and geographic location of origin by International Classification of Diseases, 10th Revision (ICD-10) block, and specific ICD-10 codes. RESULTS Comparisons of specific ICD-10 codes revealed increased rates of sepsis (P = 0.031), dementia (P = 0.049), and major depressive disorder (P = 0.005) in the study group. The collective incidence of ICD-10 codes for infections indicated that infections were more frequent contributors to death in the study group (P = 0.035). CONCLUSIONS Clinicians should be mindful of contributors to death in patients with BP and might consider screening for mental health issues, educating patients on the early symptoms of sepsis, and minimizing risk factors for infection.
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Affiliation(s)
- Benjamin J Barrick
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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137
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Abstract
Pemphigoid diseases are a group of autoimmune disorders characterized by subepidermal blistering and autoantibodies against structural proteins of the dermal-epidermal junction. In bullous pemphigoid, the most common subepidermal blistering autoimmune disease, antibodies are directed against the hemidesmosomal antigens BP180 (collagen type XVII) and BP230. Bullous pemphigoid typically presents with severe pruritus and tense blisters accompanied by erosions and crusts in elderly patients. Diagnostic landmarks are the detection of linear IgG and/or C3 deposits at the dermo-epidermal junction by direct immunofluorescence microscopy of a perilesional biopsy and the detection of serum autoantibodies by indirect immunofluorescence microscopy on human salt-split skin and ELISA employing recombinant immunodominant fragments of BP180 and BP230. Treatment options include topical (class IV) and/or systemic corticosteroids, frequently combined with immunomodulatory agents like dapsone and tetracyclines or immunosuppressants such as methotrexate and azathioprine.
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Ruocco E, Wolf R, Caccavale S, Brancaccio G, Ruocco V, Lo Schiavo A. RETRACTED: Bullous pemphigoid: Associations and management guidelines. Clin Dermatol 2013; 31:400-412. [DOI: 10.1016/j.clindermatol.2013.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Seppänen A. Collagen XVII: a shared antigen in neurodermatological interactions? Clin Dev Immunol 2013; 2013:240570. [PMID: 23878581 PMCID: PMC3710595 DOI: 10.1155/2013/240570] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/19/2013] [Indexed: 01/15/2023]
Abstract
Collagen XVII is a nonfibril-forming transmembrane collagen, which functions as both a matrix protein and a cell-surface receptor. It is particularly copious in the skin, where it is known to be a structural component of hemidesmosomes. In addition, collagen XVII has been found to be present in the central nervous system, thus offering an explanation for the statistical association between bullous pemphigoid, in which autoimmunity is directed against dermal collagen XVII, and neurological diseases. In support of the hypothesis that collagen XVII serves as a shared antigen mediating an immune response between skin and brain, research on animal and human tissue, as well as numerous epidemiological and case studies, is presented.
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Daniel BS, Murrell DF, Borradori L. Bullous pemphigoid: therapeutic algorithm and practical management. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.794693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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141
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della Torre R, Combescure C, Cortés B, Marazza G, Beltraminelli H, Naldi L, Borradori L. Clinical presentation and diagnostic delay in bullous pemphigoid: a prospective nationwide cohort. Br J Dermatol 2013; 167:1111-7. [PMID: 22709136 DOI: 10.1111/j.1365-2133.2012.11108.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prospective systematic analyses of the clinical presentation of bullous pemphigoid (BP) are lacking. Little is known about the time required for its diagnosis. Knowledge of the disease spectrum is important for diagnosis, management and inclusion of patients in therapeutic trials. OBJECTIVES The primary aims of the study were: (i) to characterize the clinical features of BP at time of diagnosis; and (ii) to assess the diagnostic delay in BP and its impact on prognosis METHODS All new cases of BP diagnosed in Switzerland between 1 January 2001 and 31 December 2002 were prospectively registered by means of a standardized data collection form. RESULTS One hundred-seventeen patients with BP were included in the study. 97cases (82.9%) had typical features with vesicles, blisters and/or erosions at time of diagnosis, while in the remaining cases (17.1%) only excoriations, eczematous and/or urticarial infiltrated lesions were observed. Head/neck as well as palmo-plantar involvement were found in up to 20% of patients, while mucosal lesions were present in 14.5% of the cases. Diagnosis was made after a mean of 6.1 months after the first symptoms. In patients, in whom the diagnostic delay was 4 months or more (defined as late diagnosis group), lesions were more often limited to one body area. The type of lesions did not affect the diagnostic delay. Diagnosis was made more rapidly in patients with limb involvement compared to those without. The calculated mortality rate in the early and late diagnosis group was 18.9% and 17.9%, respectively, without significant difference. CONCLUSION BP often presents with bullous lesions at time of diagnosis after a mean diagnostic delay of 6 months. Nevertheless, up to 20% of patients lack obvious blistering and postbullous erosions, mimicking thus a variety of inflammatory dermatoses. Localized disease is associated with an increased diagnostic delay, which has however no impact on prognosis.
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Affiliation(s)
- R della Torre
- Universitätsklinik für Dermatologie, Inselspital, University of Bern, 3010 Bern, Switzerland.
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142
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Wolz MM, Comfere NI, Gibson LE, Wieland CN. Anti-bullous pemphigoid 180 and 230 antibodies in asymptomatic subjects: five-year follow-up. J Am Acad Dermatol 2013; 68:686-687. [PMID: 23522418 DOI: 10.1016/j.jaad.2012.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Michael M Wolz
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
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Taghipour K, Chi CC, Bhogal B, Groves RW, Venning V, Wojnarowska F. Immunopathological characteristics of patients with bullous pemphigoid and neurological disease. J Eur Acad Dermatol Venereol 2013; 28:569-73. [PMID: 23530989 DOI: 10.1111/jdv.12136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/15/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The relationship between bullous pemphigoid (BP) and neurological disease has been the subject of numerous recent studies and BP antigens and their isoforms have been identified in the central nervous system (CNS). Whilst epidemiological data support this association, little is known about the pathomechanism behind this link and the immunological characteristics of patients with BP and neurological disease, other than multiple sclerosis (MS), has not been studied. OBJECTIVE We aimed to compare the cutaneous immune response in BP patients with and without neurological disease, to investigate whether or not there is a distinctive immunopathological profile in patients with concomitant BP and neurological disease. METHODS Seventy-two patients with BP were included and divided into two groups; those with neurological disease (BP+N, n = 43) and those without (BP-N, n = 29). Patients in BP+N group had a confirmed neurological disease by a hospital physician, neurologist or psychiatrist with positive neurological imaging where appropriate, or a Karnofsky score of 50 or less due to mental impairment. All sera were analysed with indirect immunofluorescence (IIF) using serial dilutions up to 1:120000, immunoblotting (IB) and Enzyme-linked immunosorbent assay (ELISA) for BP180 and BP230. RESULTS Median antibody titres by IIF were 1:1600 vs. 1:800 for BP-N and BP+N, respectively, although the difference did not reach statistic significance (P = 0.93, Mann-Whitney U-test). ELISA values for both BP180 and BP230 did not differ significantly between the two groups. Similarly, autoantibodies to specific antigens as identified by ELISA and IB were not related to the presence of neurological disease. CONCLUSION The results of this study indicate that patients with BP and neurological disease exhibit an immune response to both BP180 and BP230, thus the link between the CNS and the skin is not dependent on a specific antigen, but possibly both antigens or their isoforms may be exposed following a neurological insult, and play a role in generation of an immune response.
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Affiliation(s)
- K Taghipour
- Division of Genetics and Molecular Medicine, King's College, London, UK; Department of Dermatology, Oxford University Hospitals, Oxford, UK
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Abstract
Pemphigoid diseases are a group of well defined autoimmune disorders that are characterised by autoantibodies against structural proteins of the dermal-epidermal junction and, clinically, by tense blisters and erosions on skin or mucous membranes close to the skin surface. The most common of these diseases is bullous pemphigoid, which mainly affects older people and the reported incidence of which in Europe has more than doubled in the past decade. Prognosis and treatments vary substantially between the different disorders and, since clinical criteria are usually not sufficient, direct immunofluorescence microscopy of a perilesional biopsy specimen or serological tests are needed for exact diagnosis. In eight pemphigoid diseases the target antigens have been identified molecularly, which has allowed the development of standard diagnostic assays for detection of serum autoantibodies-some of which are commercially available. In this Seminar we discuss the clinical range, diagnostic criteria, diagnostic assay systems, and treatment options for this group of diseases.
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Affiliation(s)
- Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
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145
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Kupetsky EA, Rincon F. The Prevalence of Systemic Diseases Associated with Dermatoses and Stroke in the United States: A Cross-Sectional Study. Dermatology 2013; 227:330-7. [DOI: 10.1159/000354912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
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Kannarkat GT, Boss JM, Tansey MG. The role of innate and adaptive immunity in Parkinson's disease. JOURNAL OF PARKINSON'S DISEASE 2013; 3:493-514. [PMID: 24275605 PMCID: PMC4102262 DOI: 10.3233/jpd-130250] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent years, inflammation has become implicated as a major pathogenic factor in the onset and progression of Parkinson's disease. Understanding the precise role for inflammation in PD will likely lead to understanding of how sporadic disease arises. In vivo evidence for inflammation in PD includes microglial activation, increased expression of inflammatory genes in the periphery and in the central nervous system (CNS), infiltration of peripheral immune cells into the CNS, and altered composition and phenotype of peripheral immune cells. These findings are recapitulated in various animal models of PD and are reviewed herein. Furthermore, we examine the potential relevance of PD-linked genetic mutations to altered immune function and the extent to which environmental exposures that recapitulate these phenotypes, which may lead to sporadic PD through similar mechanisms. Given the implications of immune system involvement on disease progression, we conclude by reviewing the evidence supporting the potential efficacy of immunomodulatory therapies in PD prevention or treatment. There is a clear need for additional research to clarify the role of immunity and inflammation in this chronic, neurodegenerative disease.
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Affiliation(s)
- George T Kannarkat
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, USA
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147
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Venning V, Taghipour K, Mohd Mustapa M, Highet A, Kirtschig G, Hughes J, McLelland J, McDonagh A, Punjabi S, Buckley D, Nasr I, Swale V, Duarte Williams C, McHenry P, Wagle S, Amin S, Davis R, Haveron S. British Association of Dermatologists’ guidelines for the management of bullous pemphigoid 2012. Br J Dermatol 2012; 167:1200-14. [DOI: 10.1111/bjd.12072] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- V.A. Venning
- Department of Dermatology, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, U.K
| | - K. Taghipour
- Department of Dermatology, Whittington Hospital, Magdala Avenue, London N19 5NF, U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K
| | - A.S. Highet
- York Hospital, Wigginton Road, York YO31 8HE, U.K
| | - G. Kirtschig
- Vrije Universtiteit, PO Box 7057, Amsterdam NL‐1007 MB, the Netherlands
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148
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Walmsley N, Hampton P. Bullous pemphigoid triggered by swine flu vaccination: case report and review of vaccine triggered pemphigoid. J Dermatol Case Rep 2012; 5:74-6. [PMID: 22408707 DOI: 10.3315/jdcr.2011.1081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/26/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an acquired autoimmune blistering disease mainly affecting the elderly. Recent reports have shown an association with pre-existing neurodegenerative diseases. Triggers including diseases, medications and vaccination have been reported although in most patients no clear trigger is identified. MAIN OBSERVATIONS We report a case of atypical bullous pemphigoid which was strongly suspected to have been triggered by the swine flu vaccination. This is the first reported case of pemphigoid triggered by this vaccine. CONCLUSIONS The use of the swine flu vaccine is likely to increase in the future and it is important that clinicians are aware of the potential adverse effect of swine flu vaccination induced bullous pemphigoid.
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Affiliation(s)
- Natasha Walmsley
- Department of Dermatology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE2 2HA, UK
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Tsuruta D, Nishikawa T, Yamagami J, Hashimoto T. Unilateral bullous pemphigoid without erythema and eosinophil infiltration in a hemiplegic patient. J Dermatol 2012; 39:787-9. [PMID: 22506655 DOI: 10.1111/j.1346-8138.2012.01562.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
In this report, we describe an 88-year-old male stroke patient with unilateral bullous pemphigoid limited to the hemiplegic side. Physical examinations revealed multiple tense bullae with clear and/or bloody contents without apparent erythema on the right thigh and lower leg, accompanied by erosions on the right chest. Histopathologically, no eosinophils were infiltrated into and around the subepidermal bullae. Immunofluorescence revealed deposited and circulating immunoglobulin (Ig)G anti-basement membrane zone antibodies. Immunoblot assays using various antigen sources and enzyme-linked immunosorbent assay revealed that IgG antibodies in this case reacted with unique epitopes between NC16a and C-terminal domains on the 120-kDa LAD-1, the extracellular truncated form of BP180. Three observations were unique in our case. First, the distribution of bullae in our patient was limited to the hemiplegic side. Second, there was no apparent erythema clinically and no eosinophilic infiltration histopathologically. Third, the patient achieved remission without the use of oral corticosteroids. The unusual epitopes in this case may contribute to these phenomena.
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Affiliation(s)
- Daisuke Tsuruta
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
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150
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Naldi L, Cazzaniga S, Borradori L. Bullous Pemphigoid: Simple Measures for a Complex Disease. J Invest Dermatol 2012; 132:1948-50. [DOI: 10.1038/jid.2012.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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