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Ashton R, Fassihi H. Pediatric Autoimmune Bullous Disease: A Literature Review and Update on Management. Pediatr Rev 2022; 43:309-321. [PMID: 35641451 DOI: 10.1542/pir.2021-005125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric autoimmune bullous disease is a rare group of blistering skin disorders in children that result from autoimmunity against intercellular and basement membrane antigens in the skin and mucous membranes. Most pediatric cases are treated with oral corticosteroids or longer-term immunosuppressants such as azathioprine or mycophenolate mofetil. Immunomodulating drugs such as rituximab are increasingly being considered as options for refractory disease.
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Affiliation(s)
| | - Hiva Fassihi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, England
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2
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Brown H, Lamrock E, Jenkins D. Bullous pemphigoid in adolescence, a rare demographic. Australas J Dermatol 2020; 62:e95-e97. [PMID: 32935855 DOI: 10.1111/ajd.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
Bullous pemphigoid is rarely seen in adolescence, and its presentation, clinical course, and treatment can differ to that found in other age groups. We present a case of bullous pemphigoid in a 16-year-old with features of koebnerisation and oral mucosal involvement and provide a brief review of paediatric bullous pemphigoid.
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Affiliation(s)
- Hilary Brown
- Kotara Family Practice, Kotara, New South Wales, Australia
| | - Edwina Lamrock
- Department of Dermatology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - David Jenkins
- Department of Dermatology, John Hunter Hospital, New Lambton, New South Wales, Australia
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3
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Lalor LE, Chiu YE. Rare Vesiculopustular Eruptions of the Neonatal Period. Clin Perinatol 2020; 47:53-75. [PMID: 32000929 DOI: 10.1016/j.clp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
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Affiliation(s)
- Leah E Lalor
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Yvonne E Chiu
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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4
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Abstract
Bullous pemphigoid is the most frequent autoimmune bullous disease and mainly affects elderly individuals. Increase in incidence rates in the past decades has been attributed to population aging, drug-induced cases and improvement in the diagnosis of the nonbullous presentations of the disease. A dysregulated T cell immune response and synthesis of IgG and IgE autoantibodies against hemidesmosomal proteins (BP180 and BP230) lead to neutrophil chemotaxis and degradation of the basement membrane zone. Bullous pemphigoid classically manifests with tense blisters over urticarial plaques on the trunk and extremities accompanied by intense pruritus. Mucosal involvement is rarely reported. Diagnosis relies on (1) the histopathological evaluation demonstrating eosinophilic spongiosis or a subepidermal detachment with eosinophils; (2) the detection of IgG and/or C3 deposition at the basement membrane zone using direct or indirect immunofluorescence assays; and (3) quantification of circulating autoantibodies against BP180 and/or BP230 using ELISA. Bullous pemphigoid is often associated with multiple comorbidities in elderly individuals, especially neurological disorders and increased thrombotic risk, reaching a 1-year mortality rate of 23%. Treatment has to be tailored according to the patient's clinical conditions and disease severity. High potency topical steroids and systemic steroids are the current mainstay of therapy. Recent randomized controlled studies have demonstrated the benefit and safety of adjuvant treatment with doxycycline, dapsone and immunosuppressants aiming a reduction in the cumulative steroid dose and mortality.
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Affiliation(s)
- Denise Miyamoto
- Division of Dermatology, Hospital das Clínicas,
Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP),
Brazil
| | - Claudia Giuli Santi
- Division of Dermatology, Hospital das Clínicas,
Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP),
Brazil
| | - Valéria Aoki
- Department of Dermatology, Faculdade de Medicina,
Universidade de São Paulo, São Paulo (SP), Brazil
| | - Celina Wakisaka Maruta
- Department of Dermatology, Faculdade de Medicina,
Universidade de São Paulo, São Paulo (SP), Brazil
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5
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Watanabe T, Hara S, Muto J, Watanabe D, Akiyama M. Infantile bullous pemphigoid successfully treated with intravenous immunoglobulin therapy. Clin Exp Dermatol 2017; 42:576-578. [PMID: 28543802 DOI: 10.1111/ced.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- T Watanabe
- Department of Dermatology, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - S Hara
- Department of Pediatrics, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - J Muto
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - D Watanabe
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - M Akiyama
- Department of Dermatology, Nagoya University, Nagoya, Aichi, Japan
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6
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Taquin H, Chiaverini C, Lacour JP. Spectrum of Clinical Responses to Therapies in Infantile Bullous Pemphigoid. Pediatr Dermatol 2016; 33:e77-81. [PMID: 26764161 DOI: 10.1111/pde.12779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Infantile bullous pemphigoid (BP) is a rare autoimmune dermatosis characterized by the presence of antibodies against basal membrane zone proteins. Histologic and immunologic features are similar to those of the adult disease, but its clinical features may vary in children. We report here four cases of infantile BP whose atypical presentation or progression shed new light on the disease.
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Affiliation(s)
- Hélène Taquin
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Christine Chiaverini
- Department of Dermatology, University Hospital of Nice, Nice, France
- Department of Pediatrics, Nice Centre Hospitalier Universitaire Lenval Pediatric Hospital, Nice, France
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7
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van Beek N, Schulze FS, Zillikens D, Schmidt E. IgE-mediated mechanisms in bullous pemphigoid and other autoimmune bullous diseases. Expert Rev Clin Immunol 2015; 12:267-77. [PMID: 26588556 DOI: 10.1586/1744666x.2016.1123092] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Autoimmune bullous diseases (AIBDs) are characterized by autoantibodies against structural proteins of the dermal-epidermal junction (in pemphigoid diseases) and the epidermal/ epithelial desmosomes (in pemphigus diseases). By far, the most common AIBD is bullous pemphigoid, which is immunopathologically characterized by autoantibodies against BP180 (type XVII collagen) and BP230. IgG and, to a lesser extent, IgA autoantibodies are the major autoantibody isotypes in these disorders. IgE autoantibodies are increasingly reported in particular in bullous pemphigoid. The development of specific and sensitive anti-BP180 IgE ELISA systems, the report of two experimental murine models employing IgE autoantibodies against BP180, and the successful treatment of bullous pemphigoid with the anti-IgE antibody omalizumab have raised interest in the role of IgE autoantibodies and the modulation of their production in AIBDs. Here, the relevance of IgE autoantibodies in the diagnosis, pathophysiology, and treatment decisions of AIBDs, with a focus on bullous pemphigoid, is reviewed.
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Affiliation(s)
- Nina van Beek
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
| | - Franziska S Schulze
- b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Detlef Zillikens
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
| | - Enno Schmidt
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
- b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
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8
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Schwieger-Briel A, Moellmann C, Mattulat B, Schauer F, Kiritsi D, Schmidt E, Sitaru C, Ott H, Kern JS. Bullous pemphigoid in infants: characteristics, diagnosis and treatment. Orphanet J Rare Dis 2014; 9:185. [PMID: 25491396 PMCID: PMC4302581 DOI: 10.1186/s13023-014-0185-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/07/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bullous pemphigoid (BP) in infants is a rare but increasingly reported autoimmune blistering skin disease. Autoantibody reactivity is usually poorly characterized. Current guidelines do not address specific aspects of the infantile form of BP. The objectives of this study are to define clinical and diagnostic characteristics of infantile BP and develop a treatment algorithm. METHODS Detailed characterization of a current case series of five infants with BP from our departments. Comprehensive analysis of all reported cases (1-12 months) with respect to clinical and laboratory characteristics, treatment and outcome. RESULTS In total 81 cases were identified (including our own). The mean age was 4.5 months. Moderately severe and severe disease was seen in 84% of cases. Involvement of hands and feet was present in all cases. Immunofluorescence microscopy was comparable with BP in adults. Where analyzed, the NC16A domain of bullous pemphigoid 180 kDa antigen/collagen XVII (BP180) was identified as the major target antigen. BP180 NC16A ELISA values in our cohort were significantly higher than in a control cohort of 28 newly diagnosed adult patients. 50% of patients were treated with systemic corticosteroids, 20% with a combination of systemic corticosteroids and dapsone or sulfapyridine and 10% with topical corticosteroids alone. 14% of patients needed a combination of multiple immunosuppressants. All but one patient reached remission. Relapses were rare. CONCLUSIONS Presentation of infantile BP is often severe with blistering of hands and feet present in all cases. Pathogenesis and diagnostic criteria are comparable to adult BP, yet BP180 NC16A ELISA levels seem to be significantly higher in infants. The overall disease outcome is favorable. Based on the results of this study we propose a treatment algorithm for infantile BP.
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Affiliation(s)
- Agnes Schwieger-Briel
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany. .,Department of Dermatology, Medical Center - University of Freiburg, Hauptstrasse 7, Freiburg, 79104, Germany.
| | - Cornelia Moellmann
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Birgit Mattulat
- Children's Hospital "Klinik am Eichert", Goeppingen, Germany.
| | - Franziska Schauer
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Dimitra Kiritsi
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Enno Schmidt
- Department of Dermatology, University of Luebeck, Luebeck, Germany.
| | - Cassian Sitaru
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Hagen Ott
- Department of Dermatology, University of Luebeck, Luebeck, Germany. .,Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
| | - Johannes S Kern
- Departments of Dermatology and Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.
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9
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Voltan E, Maeda JY, Muniz Silva MA, Maruta CW, Santi CG, de Almeida Zimbres S, Aoki V. Childhood Bullous Pemphigoid: Report of Three Cases. J Dermatol 2014; 32:387-92. [PMID: 16043903 DOI: 10.1111/j.1346-8138.2005.tb00912.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
Abstract
Bullous pemphigoid (BP) is a disorder that rarely occurs in children. We hereby describe three cases of childhood BP aged 2-4 months, which are among the youngest reported in the literature. BP was confirmed by histopathology, direct and indirect immunofluorescence with salt-split skin test and immunoblotting. These patients were successfully treated with systemic corticosteroids with a complete clinical remission.
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Affiliation(s)
- Erika Voltan
- Department of Dermatology, University of São Paulo Medical School, Brazil
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10
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Motegi SI, Abe M, Tamura A, Ishii N, Hashimoto T, Ishikawa O. Childhood Bullous Pemphigoid Successfully Treated with Diaminodiphenyl Sulfone. J Dermatol 2014; 32:809-12. [PMID: 16361732 DOI: 10.1111/j.1346-8138.2005.tb00849.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 05/02/2005] [Indexed: 11/29/2022]
Abstract
Bullous pemphigoid (BP) is an acquired autoimmune blistering disease which predominantly affects the elderly. It is rare in children and infants. We reported a 14-year-old girl presenting with a month history of relapsing tense bullae on the face and extremities. Histopathological examination of the lesional skin revealed a subepidermal bulla with infiltration of eosinophils, neutrophils, and lymphocytes. Direct immunofluorescence showed linear deposits of IgM and C3 at the basement membrane zone. Indirect immunofluorescence using normal human skin sections as a substrate detected IgG anti-basement membrane zone antibodies in the patient's serum and that using 1M NaCl split skin sections showed that the patient's antibodies bound to the epidermal side of the split skin. Immunoblot analysis using normal human epidermal extracts demonstrated the presence of autoantibodies against the 230-kDa BP antigen. Furthermore, the patient's serum reacted with the recombinant protein of the NC16a domain of the 180-kDa BP antigen by immunoblot analysis and enzyme-linked immunosorbent assay. Our patient showed significant improvement of the skin lesions with systemic administration of diaminodiphenyl sulfone.
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Affiliation(s)
- Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
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11
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Vesiculobullous Diseases. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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Otten JV, Hashimoto T, Hertl M, Payne AS, Sitaru C. Molecular diagnosis in autoimmune skin blistering conditions. Curr Mol Med 2014; 14:69-95. [PMID: 24160488 PMCID: PMC3905716 DOI: 10.2174/15665240113136660079] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/12/2013] [Accepted: 06/04/2013] [Indexed: 12/22/2022]
Abstract
Blister formation in skin and mucous membranes results from a loss of cell-cell or cell-matrix adhesion and is a common outcome of pathological events in a variety of conditions, including autoimmune and genetic diseases, viral and bacterial infections, or injury by physical and chemical factors. Autoantibodies against structural components maintaining cell-cell and cell-matrix adhesion induce tissue damage in autoimmune blistering diseases. Detection of these autoantibodies either tissue-bound or circulating in serum is essential to diagnose the autoimmune nature of disease. Various immunofluorescence methods as well as molecular immunoassays, including enzyme-linked immunosorbent assay and immunoblotting, belong to the modern diagnostic algorithms for these disorders. There is still a considerable need to increase awareness of the rare autoimmune blistering diseases, which often show a severe, chronic-relapsing course, among physicians and the public. This review article describes the immunopathological features of autoimmune bullous diseases and the molecular immunoassays currently available for their diagnosis and monitoring.
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Affiliation(s)
| | | | | | | | - C Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, D-79104 Freiburg, Germany.
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13
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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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14
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Aakhus AE, McIntee TJ, Stratman EJ. Trauma-associated juvenile bullous pemphigoid in a teenager with Crohn's disease. Pediatr Dermatol 2012; 29:625-8. [PMID: 22010881 DOI: 10.1111/j.1525-1470.2011.01556.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bullous pemphigoid is an autoimmune blistering disorder rarely seen in the pediatric population. We report a case of trauma-associated bullous pemphigoid presenting in a 15-year-old boy with Crohn's disease while on immunosuppressive therapy.
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Affiliation(s)
- Angela E Aakhus
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
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15
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Pemphigoïde bulleuse du nourrisson. Ann Dermatol Venereol 2012; 139:555-8. [DOI: 10.1016/j.annder.2012.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/26/2012] [Accepted: 05/02/2012] [Indexed: 11/22/2022]
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Valdivielso-Ramos M, Velázquez D, Tortoledo A, Hernanz J. Penfigoide ampolloso infantil en relación con la vacunación hexavalente, meningococo y neumococo. An Pediatr (Barc) 2011; 75:199-202. [DOI: 10.1016/j.anpedi.2011.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/28/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022] Open
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17
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Hafiji J, Bhogal B, Rytina E, Burrows NP. Bullous pemphigoid in infancy developing after the first vaccination. Clin Exp Dermatol 2011; 35:940-1. [PMID: 21054491 DOI: 10.1111/j.1365-2230.2010.03839.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Hafiji
- Department of Dermatology, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
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18
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Bullous pemphigoid in infancy: Clinical and epidemiologic characteristics. J Am Acad Dermatol 2008; 58:41-8. [DOI: 10.1016/j.jaad.2007.08.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 07/24/2007] [Accepted: 08/01/2007] [Indexed: 11/24/2022]
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19
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Sugawara N, Nagai Y, Matsushima Y, Aoyama K, Ishikawa O. Infantile bullous pemphigoid treated with intravenous immunoglobulin therapy. J Am Acad Dermatol 2007; 57:1084-9. [PMID: 17889964 DOI: 10.1016/j.jaad.2007.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 06/28/2007] [Accepted: 08/11/2007] [Indexed: 11/22/2022]
Abstract
A 3-month-old boy presented with a 2-week history of rapidly spreading skin rashes. Physical examination revealed generalized urticarial plaques with tense bullae and small vesicles. Histologic examination and immunofluorescence established the diagnosis of bullous pemphigoid. The disease was resistant to conventional therapies with the combination of corticosteroids, dapsone, and erythromycin. Finally, intravenous immunoglobulin therapy brought about a remarkable improvement. We suggest that intravenous immunoglobulin therapy is a valuable treatment option for intractable bullous pemphigoid in infants as well as in adults.
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Affiliation(s)
- Nobuyuki Sugawara
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan.
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20
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Abstract
Bullous pemphigoid is an acquired autoimmune subepidermal blistering disorder mostly seen in the elderly. Childhood bullous pemphigoid is very rare. For the first time we report a case of childhood bullous pemphigoid associated with infantile eczema. Two weeks after a routine vaccination, a 3.5-month-old boy with infantile eczema developed a generalized blistering disorder. Histopathology revealed a subepidermal blister. Direct immunofluorescence showed linear depositions of C3 along the basement membrane zone. Indirect immunofluorescence studies demonstrated the presence of circulating immunoglobulin G antibodies directed against the epidermal side of salt-split skin. Enzyme-linked immunosorbent assay demonstrated serum level of anti-BP180 antibody elevated. The patient was successfully treated by high-dose i.v. immunoglobulin.
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Affiliation(s)
- Ting Xiao
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
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21
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Nanda A, Nanda M, Dvorak R, Al-Sabah H, Alsaleh QA. Bullous pemphigoid (BP) in an infant complicated by tuberculous meningoencephalitis. Int J Dermatol 2007; 46:964-6. [PMID: 17822503 DOI: 10.1111/j.1365-4632.2007.03194.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Arti Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait
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22
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Campos Domínguez M, Suárez Fernández R, Lázaro Ochaita P. Métodos diagnósticos en las enfermedades ampollosas subepidérmicas autoinmunes. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:485-502. [PMID: 17067526 DOI: 10.1016/s0001-7310(06)73450-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is considerable clinical and histological overlap among the subepidermal autoimmune bullous diseases. The knowledge at the molecular level of the dermo-epidermal junction is essential to understand this group of diseases. The immune-based techniques have contributed to increase the knowledge of these entities and have been progressively incorporated into clinical practice. In this review of the diagnostic methods of subepidermal autoimmune bullous diseases we summarize the most recent advances on the molecular biology of the dermo-epidermal junction, focusing on the immune-based diagnostic techniques. We distinguish two main groups of diagnostic methods: those that detect autoimmune deposits in the skin (direct immunofluorescence and its variants including confocal microscopy) and those that detect antibodies in serum or in other fluids (indirect immunofluorescence and its variants, ELISA, immunoblot and immunoprecipitation). We explain the methodology and diagnostic keys of the techniques most widely applied in our milieu.
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Affiliation(s)
- Minia Campos Domínguez
- Unidad de Enfermedades Ampollosas, Hospital General Universitario Gregorio Marañón, Madrid, España.
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23
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Chiavérini C, Hamel-Teillac D, Gilbert D, Prost Y. Absence of anti-BP180 antibodies in mothers of infants with bullous pemphigoid. Br J Dermatol 2006; 154:839-43. [PMID: 16634883 DOI: 10.1111/j.1365-2133.2005.07061.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is not clear whether bullous pemphigoid (BP) of infancy is linked to maternal transmission of pathogenic autoantibodies. Objectives To search for anti-BP180 antibodies in the sera of infants with BP and their mothers, using sensitive and specific methods. METHODS Four infants (<6 months) with BP and their mothers were tested for anti-BP180 antibodies by indirect immunofluorescence, immunoblotting and enzyme-linked immunosorbent assay (ELISA). RESULTS We found anti-BP180 antibodies in the sera of the four infants with all methods. These antibodies reacted with the extracellular domain NC16A. In the serum of their mothers we found 180 and 160 kDa proteins, each in one case, but indirect immunofluorescence and ELISA were negative, suggesting the absence of anti-BP180 autoantibodies reacting with the extracellular domain NC16A. CONCLUSIONS BP of infants is not due to maternofetal transmission of pathogenic autoantibodies. Other hypotheses for the pathophysiology of BP are discussed.
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Affiliation(s)
- C Chiavérini
- Department of Dermatology, Hospital Necker-Enfants Malades, Paris, and Clinical and Experimental Immunology Laboratory, University of Medicine, Rouen, France.
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24
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Geyer AS, Zillikens D, Skrobek C, Cohen B, Anhalt GJ, Nousari HC. Vesicular pemphigoid in a 16-year-old boy. J Am Acad Dermatol 2003; 49:722-4. [PMID: 14512926 DOI: 10.1067/s0190-9622(03)00515-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a case of a 16-year-old African-American boy with bullous pemphigoid (BP), an acquired autoimmune blistering disease that is rarely seen in children. The patient's lesions, however, were distinctly herpetiform, complicating initial diagnosis and therapy. A diagnosis of BP was made by direct and indirect immunofluorescence. Immunoblotting and enzyme-linked immunosorbent assay analysis confirmed the presence of autoantibodies directed against the BP180 antigen. The autoantibodies reacted with the same epitopes within the immunodominant BP180 NC16A domain that have previously been shown to be the target of autoantibodies in BP. This case describes an uncommon disease in the pediatric population and should be included in the differential diagnosis in young patients with an unusual generalized vesicular eruption.
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Affiliation(s)
- Adam S Geyer
- Department of Dermatology, Johns Hopkins Medical Institutions, MD 21205, USA
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25
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Abstract
Autoimmune blistering skin diseases are exceedingly rare in children. In most cases, they are characterized by circulating autoantibodies directed against adhesion structures of the skin which subsequently induce blistering at the dermoepidermal junction or intraepidermally. The most frequent paediatric immunobullous disease is linear IgA dermatosis; all others such as pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis and pemphigus are less common than in adults. In children, mucous membranes are involved more frequently. Recent advances in the identification of the autoantigens have improved diagnostic approach and therapeutic management of blistering diseases. In most cases, treatment requires systemic immunosuppression. With respect to the chronic course of the diseases and potential complications of treatment, cooperation between dermatologists and paediatricians seems advisable.
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Affiliation(s)
- M Goebeler
- Klinik und Poliklinik für Haut- und Geschlechtskrankheiten, Universität Würzburg.
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26
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Musa NJ, Kumar V, Humphreys L, Aguirre A, Neiders ME. Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child. J Periodontol 2002; 73:657-63. [PMID: 12083540 DOI: 10.1902/jop.2002.73.6.657] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cicatricial pemphigoid (benign mucous membrane pemphigoid) is an autoimmune vesiculobullous disease that affects mucosal tissues of adults and rarely presents in children. Only 9 cases in the English literature have reported cicatricial pemphigoid in children, primarily as oral mucosal lesions. This paper presents a case of childhood cicatricial pemphigoid that clinically manifested as necrotizing ulcerative gingivitis (NUG). METHODS A 9-year-old girl presented with gingival bleeding and discomfort for 2 weeks. NUG was suspected and the patient was treated with antibiotics and an oral hygiene regimen. When the condition did not improve after repeated treatment trials, routine hematoxylin and eosin (H&E) and direct immunofluorescence examinations were performed. RESULTS Microscopic examination of H&E stained sections showed a non-specific ulceration with chronic inflammation. Direct immunofluorescence studies of peri-lesional tissue showed linear deposition of C3 at the basement membrane zone that was consistent with a diagnosis of cicatricial pemphigoid. CONCLUSION Cicatricial pemphigoid is an autoimmune ulcerative condition that is rarely seen in children. Immunofluorescence studies are essential to differentiate this condition from other ulcerative oral lesions.
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Affiliation(s)
- Nour J Musa
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, NY 14214, USA.
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27
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Abstract
Bullous pemphigoid (BP) usually affects the elderly. The disease is uncommon in children and only a few cases have been described in infants < or =4 months of age. We describe two infants, ages 3 and 4 months, with BP. One infant had a recalcitrant course, and responded only to a combination of high-dose oral corticosteroids and dapsone.
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Affiliation(s)
- Danny Petronius
- Department of Dermatology and Pediatrics, Rambam Medical Center, Technion, Israel
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28
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Abstract
Transglutaminases (TGases) are enzymes that are widely used in many biological systems for generic tissue stabilization purposes. Mutations resulting in lost activity underlie several serious disorders. In addition, new evidence documents that they may also be aberrantly activated in tissues and cells and contribute to a variety of diseases, including neurodegenerative diseases such as Alzheimer's and Huntington's diseases. In these cases, the TGases appear to be a factor in the formation of inappropriate proteinaceous aggregates that may be cytotoxic. In other cases such as celiac disease, however, TGases are involved in the generation of autoantibodies. Further, in diseases such as progressive supranuclear palsy, Huntington's, Alzheimer's and Parkinson's diseases, the aberrant activation of TGases may be caused by oxidative stress and inflammation. This review will examine the role and activation of TGases in a variety of diseases.
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Affiliation(s)
- Soo Youl Kim
- Laboratory of Skin Biology, NIAMS, NIH, MD, USA.
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29
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Brenner S, Mashiah J. Autoimmune blistering diseases in children: signposts in the process of evaluation. Clin Dermatol 2000; 18:711-24. [PMID: 11173206 DOI: 10.1016/s0738-081x(00)00154-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Brenner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
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