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Schauer F, Mai S, Hofmann SC, Mai Y, Izumi K, Kern JS, Kiritsi D. Autoreactivity to BP180 Neoepitopes in Patients With Pemphigoid Gestationis. JAMA Dermatol 2022; 158:212-214. [PMID: 34985500 PMCID: PMC8733862 DOI: 10.1001/jamadermatol.2021.5294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Franziska Schauer
- Department of Dermatology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Shoko Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Silke C. Hofmann
- Department of Dermatology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany,Department of Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Yosuke Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Johannes Steffen Kern
- Department of Dermatology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany,Department of Dermatology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
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2
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Kneiber D, Kowalski EH, Amber KT. The Immunogenetics of Autoimmune Blistering Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:173-212. [DOI: 10.1007/978-3-030-92616-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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3
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Bullous Diseases of the Skin and Mucous Membranes. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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4
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Saffari H, Zone JJ, Allen M, Leiferman KM. A subset of patients with pemphigoid (herpes) gestationis has serological evidence of celiac disease. Int J Dermatol 2018; 57:534-540. [PMID: 29473148 DOI: 10.1111/ijd.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/01/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pemphigoid (herpes) gestationis (PG) is an uncommon, self-limited disease with other autoimmune associations; however, celiac disease (CD) is not recognized as one. METHODS From 71 patients' sera submitted for herpes gestationis factor (HGF) testing over a 5-year period, 12 were consistent with PG demonstrating HGF and increased IgG BP180 antibody levels; these sera were tested for IgA and IgG endomysial antibodies (EMA), epithelial basement membrane zone and cell surface antibodies by indirect immunofluorescence, and for IgA and IgG tissue transglutaminase (transglutaminase 2 or TG2) antibodies, IgA epidermal transglutaminase (transglutaminase 3 or TG3) antibodies, IgG BP230, and IgG desmoglein 1 and desmoglein 3 antibodies by enzyme-linked immunosorbent assays (ELISAs). RESULTS Three of 12 patients' sera with PG (25%) had CD antibodies with positive IgA EMA and increased IgA TG2 antibody levels; two of these had positive IgG EMA, and one other had an increased IgA TG3 antibody level. CONCLUSIONS A subset of patients with serological findings of PG also has serological evidence of CD, which may have implications in the etiopathogenesis of PG and which reveals important information about the mother's, and possibly her infant's, health.
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Affiliation(s)
- Hedieh Saffari
- Immunodermatology Laboratory, Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John J Zone
- Immunodermatology Laboratory, Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Marjorie Allen
- Immunodermatology Laboratory, Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kristin M Leiferman
- Immunodermatology Laboratory, Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, UT, USA
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5
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Sadik CD, Lima AL, Zillikens D. Pemphigoid gestationis: Toward a better understanding of the etiopathogenesis. Clin Dermatol 2016; 34:378-82. [DOI: 10.1016/j.clindermatol.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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6
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Soutou B, Aractingi S. Skin disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:732-40. [PMID: 25862358 DOI: 10.1016/j.bpobgyn.2015.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/26/2015] [Accepted: 03/06/2015] [Indexed: 11/19/2022]
Abstract
Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Universite saint-Joseph, 11-5076 Riad el Solh, Beirut, Lebanon; Centre Hospitalier du Nord, 100 Jdeidet Zgharta, Lebanon.
| | - Sélim Aractingi
- Faculté de médecine, Paris 5 descartes, Service de Dermatologie, Hôpital Cochin Tarnier, 89, rue d'Assas, 75006 Paris, France; Equipe Cellules souches foetales, Inserm UMR S 938 & UPMC, CDR St Antoine, 27, rue de Chaligny, 75012 Paris, France.
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7
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Soutou B, Aractingi S. [Pregnancy-specific dermatoses]. Rev Med Interne 2014; 36:198-202. [PMID: 25194221 DOI: 10.1016/j.revmed.2014.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/31/2014] [Indexed: 11/16/2022]
Abstract
Pregnancy-specific dermatoses include polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Intrahepatic cholestasis of pregnancy and impetigo herpetiformis are not real pregnancy-specific dermatoses but they are important to know considering the fetal and maternal risks. Polymorphic eruption of pregnancy is a pruritic disease that usually occurs in primiparous women during the last trimester of pregnancy. Atopic eczema of pregnancy is still controversial as an entity covering conditions with eczematous lesions, prurigo, or folliculitis, and inconstantly associated with a personal history of atopy. Skin biopsy with direct immunofluorescence or search for serum anti-BPAg1 (180kD) NC16a antibodies is mandatory in pruritic dermatoses of pregnancy in order to rule out pemphigoid gestationis. Serum bile salts levels should be tested whenever a generalized pruritus develops during pregnancy in order to rule out intrahepatic cholestasis.
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Affiliation(s)
- B Soutou
- Faculté de médecine, université Saint-Joseph, 11-5076 Riad el Solh, Beyrouth, Liban; Centre hospitalier du Nord, 100, Jdeidet Zgharta, Liban.
| | - S Aractingi
- Service de dermatologie, hôpital Cochin Tarnier, faculté de médecine Paris 5 Descartes, 89, rue d'Assas, 75006 Paris, France; Inserm UMR S 938, UPMC, équipe cellules souches fœtales, CDR Saint-Antoine, 27, rue de Chaligny, 75012 Paris, France
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8
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Edhegard KD, Hall RP. Bullous diseases of the skin and mucous membranes. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Pemphigoid gestationis: Current insights into pathogenesis and treatment. Eur J Obstet Gynecol Reprod Biol 2009; 145:138-44. [DOI: 10.1016/j.ejogrb.2009.05.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 04/14/2009] [Accepted: 05/13/2009] [Indexed: 11/24/2022]
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10
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JENKINS R, JONES SVAUGHAN, BLACK M. Conversion of pemphigoid gestationis to bullous pemphigoid- two refractory cases highlighting this association. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-1047.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Szilagyi A, Blasko B, Ronai Z, Fust G, Sasvari-Szekely M, Guttman A. Rapid quantification of human complement component C4A and C4B genes by capillary gel electrophoresis. Electrophoresis 2006; 27:1437-43. [PMID: 16532521 DOI: 10.1002/elps.200500779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Complement component 4 (C4) is an important plasma protein playing a major role in the human defense mechanism against infectious diseases and inflammatory processes. The C4A and C4B genes, encoding the two isoforms of complement 4, are located in the nuclear serine/threonine protein kinase-C4A or B gene-cytochrome 21-hydroxylase-tenascin X module (RP-C4-CYP21-TNX) and manifested by variable copy numbers among individuals between zero to six in the human diploid genome. Quantification of the C4A and C4B genes has great clinical importance since unbalanced production of C4A and C4B proteins might be associated with pathological immune processes. Albeit, high-throughput analysis methods for C4 gene dosage determination are not yet available. Here we present a novel combination of allele-specific PCR and CGE separation for rapid quantification of the C4A and C4B genes where a single-step, single-tube PCR reaction generates two allele-specific (C4A and C4B) and two control amplicons, followed by CGE analysis of the four fragments. The method presented in this paper enables automated and high-throughput gene dosage analysis of large sample cohorts.
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Affiliation(s)
- Agnes Szilagyi
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
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12
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Penfigoide gestacional: estudio de 9 casos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Herpes gestationis (penfigoide gestacional). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Nanda A, Al-Saeed K, Dvorak R, Al-Muzairai I, Al-Sabah H, Al-Arbash M, Alsaleh QA. Clinicopathological features and HLA tissue typing in pemphigoid gestationis patients in Kuwait. Clin Exp Dermatol 2003; 28:301-6. [PMID: 12780719 DOI: 10.1046/j.1365-2230.2003.01282.x] [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: 11/20/2022]
Abstract
Pemphigoid gestationis (PG) is a rare autoimmune disease of pregnancy. We report a series of 22 cases of PG in Kuwait. They constituted 18% of all the autoimmune bullous diseases registered in our centre over a span of 11 years. PG was observed to be the third most common bullous disease in our region. Ninety-five per cent of the patients were of Arab ethnicity. The clinical features observed in our patients were comparable to those reported elsewhere. Systemic steroids (prednisolone 20-60 mg daily) remained the mainstay of treatment to control the active disease and an optimal dose of 20 mg of prednisolone was maintained throughout the pregnancy and immediate postpartum period. We observed a favourable outcome of pregnancies complicated by PG without any associated maternal or foetal morbidity. Kuwaiti patients with PG were observed to have a predominance of HLA-DR3 and DQ2 antigens. No predominance of HLA-DR4 antigen was observed.
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Affiliation(s)
- A Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
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15
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Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol 2003; 188:1083-92. [PMID: 12712115 DOI: 10.1067/mob.2003.129] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We conducted an evidence-based systematic analysis of the literature on specific dermatoses of pregnancy. STUDY DESIGN The bibliographic databases MEDLINE and EMBASE were screened for studies and reports in all languages about herpes gestationis, pruritic urticarial papules and plaques of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy from January 1962 to January 2002. As main index terms, including analogs and derivatives, we used the names of specific dermatoses of pregnancy. Intrahepatic cholestasis of pregnancy, not a primary dermatosis, was included herein because this disorder is associated with pregnancy and its secondary skin manifestations must be differentiated from specific dermatoses of pregnancy. Other sources were abstract books of symposia and congresses, theses, textbooks, monographs, reviews, editorials, letters to the editor, free or rapid communications, and the reference lists from all the articles that were retrieved. All articles selected for inclusion in this review were evaluated critically with regard to their impact factor and evidence-based contribution to this field, as measured by their citation index and impact factor of the journal in which they were published. Approximately 39% of articles met the selection criteria. RESULTS The clinical features and prognosis of the specific dermatoses of pregnancy have been delineated through a number of retrospective and cohort studies. The molecular biologic and immunogenetic properties of herpes gestationis, pruritic urticarial papules and plaques of pregnancy, and intrahepatic cholestasis of pregnancy have been further clarified. A meta-analysis in this review reveals a higher prevalence of multiple gestation pregnancy (11.7%) among patients with pruritic urticarial papules and plaques of pregnancy. Several investigations have unraveled the fetal complications in intrahepatic cholestasis of pregnancy and herpes gestationis. New treatment modalities in intrahepatic cholestasis of pregnancy (cholestyramine, ursodeoxycholic acid) and herpes gestationis (cyclosporin, intravenous immunoglobulin, and tetracyclines postpartum) have shown promise and warrant further evaluation. CONCLUSION During the past few decades, a significant amount of new data has provided new insights into the classification, pathogenesis, treatment, prognosis, and fetal risks that are associated with the specific dermatoses of pregnancy.
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Affiliation(s)
- George Kroumpouzos
- Division of Dermatology, Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Newton
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16
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17
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Gee BC, Allen J, Khumalo NP, Wojnarowska F. Bullous pemphigoid in pregnancy: contrasting behaviour in two patients. Br J Dermatol 2001; 145:994-7. [PMID: 11899156 DOI: 10.1046/j.1365-2133.2001.04516.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bullous pemphigoid (BP) is an increasingly common immunobullous disease of the elderly, and, due to the late age of onset, is rarely seen in women of fertile age. Consequently, to the best of our knowledge no cases of BP in pregnancy have been described. We present two cases of BP that have differed in disease behaviour during pregnancy.
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Affiliation(s)
- B C Gee
- Department of Dermatology, Churchill Hospital, Headington, Oxford, UK.
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18
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Abstract
Eighty-seven patients with toenail onychomycosis were treated with intermittent low-dose itraconazole, 200 mg day(-1) for one week every four weeks; this regimen was repeated six times. A total of 77 patients (88.5%) showed microscopical and cultural cure after 6 months of treatment. A three-year follow-up showed a relapse rate of 6.5% occurring only during the first year after treatment.
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Affiliation(s)
- A Ingber
- Department of Dermatology, Hadassah University Hospital, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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19
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Affiliation(s)
- M S Lin
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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20
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Abstract
The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.
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Affiliation(s)
- G Kroumpouzos
- Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
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21
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Abstract
UNLABELLED Pregnancy is associated with immunological, endocrine, metabolic and vascular changes that may adversely affect the skin. The specific dermatoses of pregnancy are disease entities almost exclusively related to the pregnancy or the puerperium. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be aware of the main entities of the specific pregnancy dermatoses, their clinical presentations, the main diagnostic criteria and therapeutic options.
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Affiliation(s)
- S I Al-Fares
- Department of Dermatological Immunopathology, St John's Institute of Dermatology, Guy's King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK
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22
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Abstract
Pemphigoid gestationis is a rare autoimmune vesiculobullous skin disease closely related to the pemphigoid group of blistering disorders. It is unique in that it is most frequently associated with pregnancy. Diagnosis is made on the basis of the presence of a subepidermal vesicle on routine histologic examination and of linear deposition of the third component of complement along the basement membrane zone of perilesional skin. Abnormal expression of major histocompatibility complex class II molecules in the placenta may trigger the initiating immunologic event in this organ, which is followed by cross-reactivity with an antigen present in the skin and the characteristic cutaneous signs of the disease. The immunogenetics of this disorder are interesting. A role for the involvement of major histocompatibility complex class II antigens seems likely because of the association with human leukocyte antigens DR3 and DR4. Major histocompatibility complex class III associations have also been observed, as has a high frequency of anti-human leukocyte antigen antibodies. We review the current understanding of the molecular biologic and immunogenetic properties of this disease and discuss treatment and potential impact on the fetus.
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Affiliation(s)
- L Engineer
- Department of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine, Boston, MA, USA
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23
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Jenkins RE, Hern S, Black MM. Clinical features and management of 87 patients with pemphigoid gestationis. Clin Exp Dermatol 1999; 24:255-9. [PMID: 10457123 DOI: 10.1046/j.1365-2230.1999.00472.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pemphigoid gestationis is a rare vesiculo-bullous disorder of pregnancy. In this review we summarize the clinical data on 142 pregnancies in 87 patients complicated by pemphigoid gestationis. Our aim is to provide a comprehensive clinical overview of this disease.
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Affiliation(s)
- R E Jenkins
- St John's Institute of Dermatology, Department of Dermatopathology, Guy's, King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK
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Triffet MK, Gibson LE, Leiferman KM. Severe subepidermal blistering disorder with features of bullous pemphigoid and herpes gestationis. J Am Acad Dermatol 1999; 40:797-801. [PMID: 10321618 DOI: 10.1053/jd.1999.v40.a95644] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Herpes gestationis (HG) and bullous pemphigoid (BP) are blistering disorders with similar features, including urticarial lesions that progress to blisters and immunodeposition of C3 in a linear pattern at the basement membrane zone. Among their differences, HG is distinguished by its association with pregnancy, the puerperium, or hormonal perturbation. We describe the immunopathologic findings and clinical course in a multiparous woman with a severe blistering eruption. The patient was not pregnant. Malignancy evaluation was negative, and hormonal testing was normal. Histologic examination demonstrated a subepidermal bulla with eosinophils. Direct immunofluorescence showed C3 in a strong linear band at the dermal-epidermal junction. Indirect immunofluorescence demonstrated circulating IgG and IgG3 antibodies to basement membrane zone (epidermal component on salt-split skin), and complement-fixing IgG. Immunoprecipitation demonstrated antibodies to a 180-kd keratinocyte protein antigen. By clinical definition, this patient has BP. However, her disease presentation demonstrated features of both BP and HG.
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Affiliation(s)
- M K Triffet
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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25
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Hern S, Harman K, Bhogal BS, Black MM. A severe persistent case of pemphigoid gestationis treated with intravenous immunoglobulins and cyclosporin. Clin Exp Dermatol 1998; 23:185-8. [PMID: 9894365 DOI: 10.1046/j.1365-2230.1998.00342.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pemphigoid gestationis is an autoimmune bullous eruption specific to pregnancy. It usually presents in the second or third trimester and is characterized by postpartum exacerbations of the disease. Most cases resolve within a few months of delivery, but the disease may be more persistent, developing characteristics of bullous pemphigoid which can be difficult to treat. We now report a patient with severe pemphigoid gestationis, in whom the disease has persisted for 1.5 years postpartum and who developed features more typical of bullous pemphigoid. We discuss this phenomenon and the management of such cases.
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Affiliation(s)
- S Hern
- St. John's Institute of Dermatology, St. Thomas' Hospital, London
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26
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JENKINS R, JONES SVAUGHAN, BLACK M. Conversion of pemphigoid gestationis to bullous pemphigoid— two refractory cases highlighting this association. Br J Dermatol 1996. [DOI: 10.1111/j.1365-2133.1996.tb03838.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Shornick JK, Jenkins RE, Artlett CM, Briggs DC, Welsh KI, Kelly SE, Garvey MP, Black MM. Class II MHC typing in pemphigoid gestationis. Clin Exp Dermatol 1995; 20:123-6. [PMID: 8565245 DOI: 10.1111/j.1365-2230.1995.tb02668.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pemphigoid gestationis (PG) is a rare, autoimmune skin disease associated with pregnancy or the immediate post-partum period, previously shown to be associated with the HLA class II antigens DR3 and DR4. Advances in molecular analytical techniques now allow the identification of HLA alleles previously difficult to define by serological assays. Unsuspected polymorphism within the HLA-DR3 and DR4 classes can, therefore, be identified. The aim of our study was to apply these newer techniques to the question of genetic predisposition in PG by re-evaluating the association with DR3 and by studying a possible link with DQ. We have investigated by restriction fragment length polymorphism, the DQA, and by sequence specified oligonucleotide probing the DQB and DRB1 (HLA DR) specificities of 41 women with immunofluorescence-confirmed PG. The principal finding of this study is that there is an association between PG and DRB1*0301 (DR3) and DRB1*0401/040X (DR4). Although there is also an increase (P = 0.06) in the concurrent presence of both antigens, this appears to be due to the association with either antigen alone. We also found an increase in the frequency of DQA1*2 (P = 0.016 vs. control) and a decrease in frequency of DQB1*0201 (P = 0.022 vs. controls) and DQB1*0602 (P = 0.026 vs. controls).
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Affiliation(s)
- J K Shornick
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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28
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Kirtschig G, Collier PM, Emmerson RW, Wojnarowska F. Severe case of pemphigoid gestationis with unusual target antigen. Br J Dermatol 1994; 131:108-11. [PMID: 8043401 DOI: 10.1111/j.1365-2133.1994.tb08466.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a severe case of pemphigoid gestationis (PG) with an unusual target antigen. The patient developed a severe itchy macular rash on the abdomen during her fifth pregnancy, at 38 weeks' gestation. The disease persisted for 8 months post-partum, and could only be controlled with high doses of systemic corticosteroids and dapsone. The diagnosis of PG was confirmed by direct and indirect immunofluorescence. A linear band of IgG and C3 was detected at the epidermal aspect of salt-split skin. Immunoblotting studies revealed circulating IgG antibodies binding to a single 200-kDa protein in epidermal extracts. Immunofluorescence studies using trypsinized human keratinocytes demonstrated uniform staining around the cell peripheries, suggesting that the target antigen was not associated with hemidesmosomes. These findings differ from the usual immunological features seen in PG, and suggest further heterogeneity of the antigens involved in PG.
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Affiliation(s)
- G Kirtschig
- Department of Dermatology, University of Marburg, Germany
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