1
|
Mortazavi H, Hazrati P, Koohi H, Sarrafan-Sadeghi T, Moradian-Lotfi S. Ocular involvement in oral vesiculobullous diseases: A review on reported cases in the literature. Saudi Dent J 2024; 36:546-560. [PMID: 38690390 PMCID: PMC11056430 DOI: 10.1016/j.sdentj.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 05/02/2024] Open
Abstract
Introduction Vesiculobullous disorders are a group of autoimmune diseases manifesting as chronic ulcers in the oral cavity. Ocular involvement may accompany oral ulcers and cause various problems for patients. This review summarizes the data regarding ocular involvement in patients with oral vesiculobullous. Methods Web of Science, Scopus, PubMed/MEDLINE, and Embase electronic databases were searched according to related keywords. Finally, 58 articles were included, all of which were case reports or series. Characteristics such as the age and sex of patients, location and type of oral lesion, type of ophthalmic injury, the interval between oral and ocular lesion, and treatment of oral and ocular disorders were summarized in tables. Results Eye involvement was 1.6 times more prevalent in women, and most patients were between 30 and 60 years old (67.4 %). Pemphigus vulgaris accounted for almost half of the cases (48.4 %), though lichen planus is more prevalent in the general population. The most frequently affected oral site was the buccal mucosa (17.5 %), and oral ulcers usually presented as erythema, erosion, or inflammation (22.7 %). Conjunctivitis was the most common type of eye involvement (18.4 %), and ophthalmic lesions regularly appeared 12-60 months after the development of oral lesions (30.1 %). Blindness was reported in only one case. Corticosteroids and immunosuppressives were the most frequent oral and ocular lesion therapies. Conclusion Considering the serious burdens of any ocular injury, monitoring the ocular health of patients with oral vesiculobullous diseases is highly recommended in high-risk cases, especially middle-aged women with oral pemphigus vulgaris.
Collapse
Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Hazrati
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hediye Koohi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shima Moradian-Lotfi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Garza-Dávila VF, Santana-Gutiérrez A, Zapata-Salazar N, Vázquez-Martínez O, Ocampo-Candiani J, Fernández-de Luna ML, Mohamed-Noriega K, Alba-Rojas E. Eye and lid involvement as an uncommon feature of pemphigus foliaceus in a pediatric patient. Pediatr Dermatol 2024. [PMID: 38459607 DOI: 10.1111/pde.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
Pemphigus foliaceus (PF) is an autoimmune blistering disorder which affects the superficial layers of the epidermis with rare mucosal involvement. We present the case of a 12-year-old girl with PF involving the eyes and eyelids. A literature review of pediatric nonendemic PF revealed another two cases with ocular manifestations. Eyelid involvement is an uncommon feature of PF that should be properly identified and treated.
Collapse
Affiliation(s)
- Valeria F Garza-Dávila
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Adalberto Santana-Gutiérrez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Natalia Zapata-Salazar
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Osvaldo Vázquez-Martínez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Marissa L Fernández-de Luna
- Ophthalmolgy Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Karim Mohamed-Noriega
- Ophthalmolgy Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Erika Alba-Rojas
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| |
Collapse
|
3
|
Kurzeja M, Olszewska M, Grzybowski A, Rudnicka L. Ocular involvement in autoimmune bullous diseases. Clin Dermatol 2023; 41:481-490. [PMID: 37586570 DOI: 10.1016/j.clindermatol.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Autoimmune bullous diseases represent a heterogenous group of disorders caused by autoantibodies against adhesion molecules; the location of the target protein determines the level of cleft formation. The spectrum of ocular lesions in autoimmune bullous diseases can range from mild symptoms to severe involvement with sight impairment and even, in some cases, blindness. In pemphigus vulgaris, the prevalence of ocular involvement has been reported to be between 7% and 26%. The most common clinical sign of ocular pemphigus vulgaris is bilateral conjunctivitis with hyperemia. Ocular involvement also occurs in 41% to 70% of patients with paraneoplastic pemphigus. The main ocular manifestations are bilateral cicatrizing conjunctivitis with symblepharon formation, and shortening of the fornices. In mucous membrane pemphigoid, ocular involvement is seen in 61% to 70% of patients; the most frequent ocular finding is cicatricial conjunctivitis. Patients with autoimmune bullous diseases having common ocular involvement should be assessed by an ophthalmologist to avoid serious complications. Diagnostic procedures and treatment require multidisciplinary care based on the close cooperation between dermatologists and ophthalmologists.
Collapse
Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
4
|
Salehi M, Shahmoradi Z, Razavi SM, Lali I, Faghihian E. Adrenocorticotropic hormone (ACTH) level and adrenal deficiency in patients with mucocutaneous pemphigus. Horm Mol Biol Clin Investig 2022; 43:437-440. [PMID: 35514250 DOI: 10.1515/hmbci-2021-0097] [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: 11/25/2021] [Accepted: 03/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to evaluate the level of adrenocorticotropic hormone (ACTH) and adrenal insufficiency in patients with mucocutaneous pemphigus lesions who use oral corticosteroids. METHODS This descriptive-analytical study was performed on 54 patients (48.44 ± 12.74 years) with mucocutaneous pemphigus in 2019. Those patients taken corticosteroids in different doses and way. At first, collected patients information including age, sex, type of pemphigus, duration of use, patient dosage, duration of corticosteroid administration, and method of administration were collected daily. Adrenal gland function was measured by evaluating ACTH levels. Data were analyzed by using Pearson correlation coefficient and t-test. RESULTS Our study showed that 37 cases (68.5%) had normal ACTH average hormone level (7.3-63.3 mL/pg), 11 cases (20.4%) were lower levels (<7.2 mL/pg), and 6 cases (11.1%) were higher levels (63.3 > mL/pg). Wo observed no significant relationship between ACTH and duration of corticosteroids usage (p=0.207). CONCLUSIONS Taking a maintenance dose of between 12.5 and 25 mg daily does not usually lead to adrenal insufficiency. The present study showed that the lower the daily dose of corticosteroids, the lower the likelihood of adrenal insufficiency.
Collapse
Affiliation(s)
- Mohammadreza Salehi
- Department of Oral Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammad Razavi
- Department of Oral and Maxillofacial Pathology, Implant Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iraj Lali
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Faghihian
- Department of Oral Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Dry Eye and Quantitative and Qualitative Changes of Meibomian Glands in Patients With Pemphigus. Cornea 2020; 39:1108-1111. [DOI: 10.1097/ico.0000000000002356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
6
|
Feizi S, Roshandel D. Ocular Manifestations and Management of Autoimmune Bullous Diseases. J Ophthalmic Vis Res 2019; 14:195-210. [PMID: 31114657 PMCID: PMC6504727 DOI: 10.4103/jovr.jovr_86_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/11/2018] [Indexed: 01/09/2023] Open
Abstract
Autoimmune bullous diseases with ocular involvement consist of a group of systemic entities that are characterized by formation of autoantibodies against the proteins of the epithelial basement membrane zone of the conjunctiva. Mostly, the elderly are affected by these diseases. The characteristic patterns of mucocutaneous involvement and the specific tissue components targeted by these autoantibodies are differentiating features of these diseases. Ocular pemphigus vulgaris exhibits intraepithelial activity, whereas the autoimmune activity in linear immunoglobulin A disease, mucous membrane pemphigoid, and epidermolysis bullosa acquisita occurs at a subepithelial location. Given the increased risk for blindness with delays in diagnosis and management, early detection of ocular manifestations in these diseases is vital. The precise diagnosis of these autoimmune blistering diseases, which is essential for proper treatment, is based on clinical, histological, and immunological evaluation. Management usually includes anti-inflammatory and immunosuppressive medications. Inappropriate treatment results in high morbidity and even potential mortality.
Collapse
Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Roshandel
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
España A, Iranzo P, Herrero-González J, Mascaro JM, Suárez R. Augenbeteiligung beim Pemphigus vulgaris - retrospektive Studie an einer großen spanischen Kohorte. J Dtsch Dermatol Ges 2017; 15:396-404. [DOI: 10.1111/ddg.13221_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Agustin España
- Department of Dermatology, Unit of Autoimmune Blistering Skin Diseases; University Clinic of Navarra, School of Medicine; Pamplona Navarra Spanien
| | | | | | | | | |
Collapse
|
8
|
España A, Iranzo P, Herrero-González J, Mascaro JM, Suárez R. Ocular involvement in pemphigus vulgaris - a retrospective study of a large Spanish cohort. J Dtsch Dermatol Ges 2017; 15:396-403. [PMID: 28332775 DOI: 10.1111/ddg.13221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/08/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Ocular/periocular involvement in pemphigus vulgaris (OPV) has rarely been reported. The objective of the present study was to investigate the pattern of OPV and define the prognostic value of its manifestation. PATIENTS AND METHODS From 1985 to 2014, a total of 167 patients with pemphigus vulgaris (PV) were treated at four tertiary Spanish hospitals. In this retrospective study, we included all patients with OPV. Clinical data and information on associated symptoms were obtained from patients' medical records. RESULTS Only 24 (14.3 %) of all PV patients had ocular lesions. In most cases, -ocular involvement was preceded by PV lesions at various other sites (mean duration: 33.7 months). Ocular PV lesions occurred during flares of mucocutaneous pemphigus, and was never the only mucosal manifestation. The most common clinical signs were conjunctival hyperemia (87.5 %), erosions on the eyelids (41.6 %) as well as of the palpebral/bulbar conjunctiva (33.3 %) and at the medial epicanthus (20.8 %). The most relevant associated symptoms included local pain/stinging (71.4 %), irritation (47.6 %), photophobia (38.1 %), and epiphora (23.9 %). Ocular PV improved with systemic and adjuvant topical therapies. Only two patients experienced sequelae. CONCLUSIONS In patients with PV, ocular involvement is an exception. Ocular PV is associated with greater disease activity, and usually follows a benign course. Sites affected are the conjunctiva, the eyelids, or both.
Collapse
Affiliation(s)
- Agustin España
- Department of Dermatology, Unit of Autoimmune Blistering Skin Diseases; University Clinic of Navarra, School of Medicine, Pamplona, Navarra, Spain
| | | | | | | | | |
Collapse
|
9
|
Hansen MS, Klefter ON, Julian HO, Lynge Pedersen AM, Heegaard S. Management of patients with ocular manifestations in vesiculobullous disorders affecting the mouth. Oral Dis 2016; 23:849-853. [PMID: 27717107 DOI: 10.1111/odi.12590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 12/19/2022]
Abstract
Pemphigoid and pemphigus diseases as well as Stevens-Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon, eyelid malposition, ocular surface scarring and severe visual loss. In addition to diagnostic assessments, ophthalmologists must treat the dry eye and meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants. Topical anti-inflammatory therapy is used to treat acute inflammatory exacerbations of the ocular surface, but it cannot prevent scarring alone. Intralesional antimetabolite therapy can cause regression of conjunctival pathology in selected cases. Hence, patients with vesiculobullous disorders should be managed by a multidisciplinary team representing ophthalmology, dermatology, otolaryngology, oral medicine and pathology, internal medicine and intensive care. Systemic treatments including corticosteroids, azathioprine, cyclophosphamide, cyclosporine and mycophenolate mofetil help control inflammation. Intravenous immunoglobulins, plasmapheresis and targeted antibody therapy can be used in selected, severe and treatment-resistant cases. Local surgical management may include debridement of pseudomembranes, lysis of symblepharon, amniotic and mucous membrane grafting as well as reconstructive procedures. Prospective, multicentre, international studies are recommended to further support evidence-based practice.
Collapse
Affiliation(s)
- M S Hansen
- Department of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - O N Klefter
- Department of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - H O Julian
- Eye Clinic, Mølholm Hospital, Vejle, Denmark
| | - A M Lynge Pedersen
- Section of Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Heegaard
- Department of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
|
11
|
Broussard KC, Leung TG, Moradi A, Thorne JE, Fine JD. Autoimmune bullous diseases with skin and eye involvement: Cicatricial pemphigoid, pemphigus vulgaris, and pemphigus paraneoplastica. Clin Dermatol 2015; 34:205-13. [PMID: 26903186 DOI: 10.1016/j.clindermatol.2015.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Autoimmune blistering diseases are a heterogeneous group of disorders that mostly affect the skin and mucous membranes. Occasionally, other organ systems may be involved, depending on the unique pathophysiology of each disease. Cicatricial pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus are distinct entities, but all have the potential to have cutaneous and ocular involvement. Awareness and early recognition of ocular involvement in these diseases is important given the increased risk for vision loss and blindness with delay in management. Several skin diseases may be associated with involvement of the external eye. The most common autoimmune diseases are cicatricial pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus.
Collapse
Affiliation(s)
- Karen C Broussard
- Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, TN
| | - Theresa G Leung
- Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ahmadreza Moradi
- Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer E Thorne
- Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jo-David Fine
- Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
12
|
Betul Turkoglu E, Alan S. Intralesional triamcinolone acetonide for refractory ocular pemphigus vulgaris: A case series. J Fr Ophtalmol 2015; 38:e207-9. [DOI: 10.1016/j.jfo.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
|
13
|
Huang LC, Wong JR, Alonso-Llamazares J, Nousari CH, Perez VL, Amescua G, Karp CL, Galor A. Pseudopemphigoid as caused by topical drugs and pemphigus disease. World J Ophthalmol 2015; 5:1-15. [DOI: 10.5318/wjo.v5.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/19/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
Pseudopemphigoid can cause a chronic cicatricial conjunctivitis that is clinically identical to the manifestations seen in mucous membrane pemphigoid, a disorder with a common clinical phenotype and multiple autoimmune links. For the purpose of this review, we will describe pseudopemphigoid as caused by topical drugs, the most common etiology with ocular manifestations, and as caused by the pemphigus disease, a more rare etiology. Specifically, we will discuss the ophthalmological features of drug-induced cicatricial conjunctivitis, pemphigus vulgaris, and paraneoplastic pemphigus. Other etiologies of pseudopemphigoid exist that will not be described in this review including autoimmune or inflammatory conditions such as lichen planus, sarcoidosis, granulomatosis with polyangiitis (Wegener’s granulomatosis), erythema multiforme (minor, major, and Stevens-Johnson syndrome), bullous pemphigoid, skin-dominated linear IgA bullous dermatosis, and skin-dominated epidermolysis bullosa acquisita. Prompt diagnosis of the underlying etiology in pseudopemphigoid is paramount to the patient’s outcome as certain diseases are associated with a more severe clinical course, increased ocular involvement, and differential response to treatment. A complete history and ocular examination may find early cicatricial changes in the conjunctiva that are important to note and evaluate to avoid progression to more severe disease manifestations. When such cicatricial changes are noted, proper diagnostic techniques are needed to help elucidate a diagnosis. Lastly, collaboration between ophthalmologists and subspecialists such as dermatologists, pathologists, immunologists, and others involved in the care of the patient is needed to ensure optimal management of disease.
Collapse
|
14
|
Akhyani M, Keshtkar-Jafari A, Chams-Davatchi C, Lajevardi V, Beigi S, Aghazadeh N, Rayati Damavandi M, Arami S. Ocular involvement in pemphigus vulgaris. J Dermatol 2014; 41:618-21. [DOI: 10.1111/1346-8138.12447] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Maryam Akhyani
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Alireza Keshtkar-Jafari
- Department of Ophthalmology; Farabi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Cheyda Chams-Davatchi
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Vahide Lajevardi
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Sara Beigi
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Nessa Aghazadeh
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Maede Rayati Damavandi
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Shabnam Arami
- Department of Dermatology; Autoimmune Bullous Diseases Research Center; Razi Hospital; Tehran University of Medical Sciences; Tehran Iran
| |
Collapse
|
15
|
Chirinos-Saldaña P, Zuñiga-Gonzalez I, Hernandez-Camarena JC, Navas A, Ramirez-Luquin T, Robles-Contreras A, Jimenez-Martinez MC, Ramirez-Miranda A, Bautista-de Lucio VM, Graue-Hernandez EO. Cicatricial changes in ocular pemphigus. Eye (Lond) 2014; 28:459-65. [PMID: 24480839 DOI: 10.1038/eye.2014.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/09/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe the clinical characteristics of ocular involvement in patients with pemphigus at an ophthalmological referral center. METHODS A retrospective review was conducted on patients with the immunopathological diagnosis of pemphigus examined between 1 January 2000 and 1 April 2010. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), ocular symptoms, and ocular surface inflammatory and scarring changes were assessed. RESULTS A total of 15 patients were identified, with a mean age of 68.27 ± 14.35 years, and 80% (n=12) were female. Extraocular involvement was reported in one patient. All of the eyes showed cicatricial changes in the conjunctiva. In all, 6 eyes (20%) were classified as stage I; 12 eyes (40%) as stage II; 10 eyes (33%) as stage III; and 2 eyes (7%) as stage IV. A statistically significant association was found between BCVA and the severity of ocular involvement. The mean BCVA logMAR was 1.66 (20/914), with a range from logMAR 0 (20/20) to logMAR 4 (NLP). Other ocular diseases were found in 8 (53.3%), systemic diseases in 10 (66.7%), and the use of pemphigus-inducing drugs in 10 patients (66.7%). CONCLUSIONS The present report represents the largest series of ocular involvement in pemphigus confirmed by immunopathology. The clinical manifestations varied from conjunctival hyperemia to corneal scarring and perforation. There was a strong association between scarring changes and low BCVA. Ocular and systemic diseases as well as the use of pemphigus-inducing drugs may predispose to ocular cicatricial changes observed in this series.
Collapse
Affiliation(s)
- P Chirinos-Saldaña
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - I Zuñiga-Gonzalez
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - J C Hernandez-Camarena
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - A Navas
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - T Ramirez-Luquin
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - A Robles-Contreras
- Immunology Department, Research Unit Institute, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - M C Jimenez-Martinez
- 1] Immunology Department, Research Unit Institute, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico [2] Immunology Lab, Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - A Ramirez-Miranda
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - V M Bautista-de Lucio
- Microbiology and Ocular Proteomics Department, Research Unit, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| | - E O Graue-Hernandez
- Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico
| |
Collapse
|
16
|
Uludag HA, Uysal Y, Kucukevcilioglu M, Ceylan OM, Onguru O, Arca E. An uncommon ocular manifestation of pemphigus vulgaris: conjunctival mass. Ocul Immunol Inflamm 2013; 21:400-2. [PMID: 23718286 DOI: 10.3109/09273948.2013.791924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Huseyin Avni Uludag
- Gulhane Military Academy of Medicine, Department of Ophthalmology , Ankara , Turkey
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE Pemphigus vulgaris (PV) is an autoimmune blistering disease that affects mucous membranes and the skin. Most commonly, the disease begins in the oral cavity and spreads to other areas including the conjunctiva and eyelids. Ocular involvement is rare and likely underdiagnosed with a frequency that is underestimated. Ocular manifestations of systemic PV can imply severe disease and require a multidisciplinary approach. CASE REPORT A 43-year-old black female presented with a chief complaint of pain with a white stringy discharge in the left eye for 2 weeks. On questioning, her health history revealed a 20-year systemic history of PV. Assessment of the anterior segment revealed diffuse conjunctival hyperemia with an area of bulbar conjunctival erosion. Based on the constellation of history, signs, and symptoms, ocular PV was diagnosed precipitating treatment for the ocular lesions and referral to the dermatologist for control of the underlying systemic condition. CONCLUSIONS PV is an autoimmune disease of the pemphigus classification. It is characterized by the production of autoantibodies that attack intercellular substances. We review this unusual entity, its immunopathology, and treatment.
Collapse
|
18
|
Balica S, Bulai Livideanu C, Fournié P, Fortenfant F, Soler V, Barbarot S, Paul C. Is conjunctival mucous involvement a marker of severity in pemphigus vulgaris? J Eur Acad Dermatol Venereol 2012; 27:520-1. [PMID: 22429389 DOI: 10.1111/j.1468-3083.2012.04509.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
19
|
Sadowsky AE. Dermatologic Disorders and the Cornea. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
20
|
Multiple Conjunctival Papillomas of Eyelid Margins in Pemphigus vulgaris. Case Rep Ophthalmol Med 2011; 2011:174912. [PMID: 22611504 PMCID: PMC3350146 DOI: 10.1155/2011/174912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 12/10/2011] [Indexed: 12/02/2022] Open
Abstract
Ocular involvement in pemphigus vulgaris (PV) ranges from mild conjuctivits to conjunctival blisters and rarely prominent erosions of the bulbar and palpebral conjunctiva which may be found at the eyelid margin. We report two unusual cases of PV patients presenting with multiple conjunctival papillomatous lesions of the eyelids margins.
Collapse
|
21
|
Kozeis N, Tyradellis S, Dragiotis E, Eleftheriadis H. Triamcinolone acetonide for rare ocular manifestations of pemphigus vulgaris: a case report. Clin Ophthalmol 2010; 4:365-8. [PMID: 20463806 PMCID: PMC2861945 DOI: 10.2147/opth.s8189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We present an interesting case of pemphigus vulgaris with severe and rare eye manifestations. An old lady with systemic and ocular manifestations of pemphigus vulgaris was treated with systemic corticosteroids and immunosuppressants, with no effect. Subconjunctival injection of triamcinolone acetate reduced the ocular signs and led to gradual reduction of the systemic medications.
Collapse
Affiliation(s)
- N Kozeis
- Department of Ophthalmology, Hippokration Hospital of Thessaloniki, Greece.
| | | | | | | |
Collapse
|
22
|
Human eyelid meibomian glands and tarsal muscle are recognized by autoantibodies from patients affected by a new variant of endemic pemphigus foliaceus in El-Bagre, Colombia, South America. J Am Acad Dermatol 2010; 62:437-47. [PMID: 20061054 DOI: 10.1016/j.jaad.2009.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 06/01/2009] [Accepted: 06/03/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previously, we described a new variant of endemic pemphigus foliaceus (EPF) in Colombia, South America (El Bagre-EPF). OBJECTIVE Continuing our characterization of this variant of EPF, we now focus on one of our previously reported clinical findings: the presence of ocular lesions. These ocular lesions are seen in patients having extensive skin involvement, as measured by the Lund and Browder scale, which is generally used for patients with skin burns. METHODS We specifically searched for evidence of autoreactivity to various eyelid structures in these patients and correlated our immunologic data with the clinical findings. We performed indirect immunofluorescence studies using normal-appearing human eyelid skin from routine blepharoplasties as substrate tissue. We tested sera from 12 patients with El Bagre-EPF and ocular lesions, 5 patients with sporadic (nonendemic) pemphigus foliaceus, and 20 healthy control subjects (10 from the El Bagre-EPF endemic area and 10 from nonendemic areas). We used fluorescein isothiocyanate conjugated goat antiserum to human total IgG/IgA/IgM as a secondary antibody. In addition, we used fluorescein isothiocyanate conjugated antibodies to human fibrinogen, albumin, IgG, IgE, C1q, and C3, Texas Red (Rockland Immunochemicals, Inc, Gilbertsville, PA), Alexa Fluor 555, or Alexa Fluor 594 (Invitrogen, Carlsbad, CA). Ki-67 (a cell proliferation marker) was used to determine the cell proliferation rate, and nuclear counterstaining was performed with either 4', 6-diamidino-2-phenylindole or Topro III (Invitrogen, Carlsbad, CA). RESULTS We observed autoreactivity to multiple eyelid structures, including meibomian glands and tarsal muscle bundles at different levels, and some areas of the epidermis and the dermis close to the isthmus of the eyelids. Tarsal plate autoreactivity was seen in 10 of 12 of the El Bagre-EPF sera and in one control with pemphigus erythematosus. Furthermore, immunoprecipitation using an eyelid sample as a substrate with 1 mmol/L of sodium orthovanodate showed autoreactivity to several antigens, including some of possible lipid origin. LIMITATIONS The main limitation of this study is the fact that the antigen or antigens remain unknown. CONCLUSION We identified for the first time to our knowledge autoantibodies to meibomian glands and tarsal muscle in El Bagre-EPF. Our findings suggest that the autoantibodies to the ocular structures cause the clinical and histopathological findings in the ocular lesions in El Bagre-EPF.
Collapse
|
23
|
Abstract
Ocular manifestations are a comorbidity of a group of chronic autoimmune blistering diseases that includes mucous membrane pemphigoid, linear immunoglobulin A disease, epidermolysis bullosa acquisita, and ocular pemphigus vulgaris. Various diagnostic measures differentiate between the diseases and allow for appropriate treatment including a specific selection of immunomodulatory medications. New treatment modalities offer alternatives that may minimize disease severity and residual tissue damage and may reduce treatment-related complications.
Collapse
|
24
|
Olszewska M, Komor M, Mazur M, Rogozinski T. Response of ocular pemphigus vulgaris to therapy. Case report and review of literature. J Dermatol Case Rep 2008; 2:1-3. [PMID: 21886701 DOI: 10.3315/jdcr.2008.1006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 02/25/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pemphigus vulgaris is an autoimmune bullous disease characterized by blistering and erosions within skin and mucous membranes. Lesions appear most commonly on mucosal surfaces of the oral cavity. Ocular involvement in patients with PV has rarely been reported. MAIN OBSERVATION A 47-year-old male patient with a 2 month history of oral erosions and dysphagia developed severe conjunctivitis with periodical presence of purulent discharge, photophobia and burning sensations. The diagnosis of pemphigus vulgaris was confirmed by histopathology, direct immunofluorescence and detection of anti-desmogelin 3 antibodies in patients' serum. Treatment was introduced with prednisone at a dose of 80 mg per day (1 mg/kg) and cyclophosphamide at a dose of 100 mg daily (1.25 mg/kg). After 7 days of therapy a significant reduction of eye symptoms was observed and after 4 weeks of treatment full clinical remission was achieved. CONCLUSIONS The grounds for rare involvement of conjunctiva in pemphigus vulgaris is unclear. We hypothesize that inactivation of conjunctival desmoglein 3 may be compensated by other desmosomal proteins. Severe conjunctivitis may be the dominating clinical manifestation in pemphigus vulgaris. This implies a need of establishing distinct severity criteria and therapeutic standards for ocular pemphigus. In our patient rapid clinical response was achieved after introducing combined treatment with prednisone and oral cyclophosphamide.
Collapse
|