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Iwata H, Vorobyev A, Koga H, Recke A, Zillikens D, Prost-Squarcioni C, Ishii N, Hashimoto T, Ludwig RJ. Meta-analysis of the clinical and immunopathological characteristics and treatment outcomes in epidermolysis bullosa acquisita patients. Orphanet J Rare Dis 2018; 13:153. [PMID: 30180870 PMCID: PMC6122731 DOI: 10.1186/s13023-018-0896-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background Epidermolysis bullosa acquisita (EBA) is an orphan autoimmune disease. Several clinical phenotypes have been described, but subepidermal blistering is characteristic of all variants. Limited data on clinical and immunopathological characteristics and treatment outcomes in EBA are available. To fill this gap, we collected this information from EBA cases, meeting current diagnostic criteria, published between 1971 and 2016. Results We identified 1159 EBA cases. This number must be, however, interpreted with caution, as it is not possible to check for multiple reporting. The analysis of all cases indicated that EBA affects all age groups (median: 50 years, range: 1 to 94 years) at an equal gender distribution. Non-mechanobullous (non-MB) forms of EBA were observed in 55% of patients, whereas the mechanobullous variant (MB-EBA) or a combination of both variants was described in 38 or 7% of patients, respectively. Type VII collagen (COL7)-specific autoantibodies were primarily of the IgG isotype, but anti-COL7 IgA, IgM and IgE were also documented. Comparison of the 2 clinical EBA types showed a higher frequency of IgA deposits in non-MB EBA as opposed to MB EBA. Mucous membrane involvement was observed in 23% of patients, and 4.4% of cases were associated with other chronic inflammatory diseases. Of note, IgA deposits were more frequently observed in cases with mucous membrane involvement. Our analysis indicated that EBA is difficult to treat and that the choice of treatment varies widely. Chi square was applied to identify medications associated with complete remission (CR). Considering all EBA cases, intravenous immunoglobulin (IVIG, p = 0.0047) and rituximab (p = 0.0114) were associated with CR. Subgroup analysis demonstrated that no treatment was associated with CR for non-MB EBA, while IVIG (p = 0.003) was associated with CR in MB EBA. Conclusions Within the limitations of the study, we here document the clinical and immunopathological characteristics and treatment outcomes in a large cohort of EBA patients. The observed associations of single drugs with treatment outcome may serve as a guide to develop clinical trials. Electronic supplementary material The online version of this article (10.1186/s13023-018-0896-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroaki Iwata
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.,Present address: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Artem Vorobyev
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Hiroshi Koga
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.,Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Catherine Prost-Squarcioni
- Referral center for auto-immune bullous diseases, Department of Dermatology, APHP, Avicenne Hospital, Bobigny, France
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Faculty of Medicine, Osaka City University, Osaka, Japan
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany. .,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
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Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
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Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
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Spiliopoulos S, Sabharwal T, Krokidis M, Gkoutzios P, Mellerio J, Dourado R, Adam A. Fluoroscopically guided dilation of esophageal strictures in patients with dystrophic epidermolysis bullosa: long-term results. AJR Am J Roentgenol 2012; 199:208-12. [PMID: 22733914 DOI: 10.2214/ajr.11.8159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the immediate and long-term outcomes after fluoroscopically guided balloon dilation of esophageal strictures in a series of patients with dystrophic epidermolysis bullosa (DEB). MATERIALS AND METHODS Between 2005 and 2011, the medical records of all patients with DEB treated with fluoroscopically guided balloon dilation of esophageal strictures were included in the study and retrospectively analyzed. The indication for treatment was dysphagia attributed to at least one radiologically verified esophageal stricture. The primary endpoints of the study included procedural technical success, clinical improvement assessed with a 0-4 dysphagia score, and major complication rate. Secondary endpoints were patient survival and reintervention rates. RESULTS Nineteen consecutively registered patients with DEB (age range, 10-51 years; mean, 30 ± 12.2 years) and dysphagia due to esophageal strictures were treated with fluoroscopically guided balloon dilation. In total, 90 procedures and 121 dilations were performed to manage 28 lesions. Balloon diameter ranged from 8 to 18 mm. The mean follow-up time was 47.51 ± 16.64 months (range, 17-73 months). The technical success rate was 96.7% (87/90). There were no major complications. The mean reintervention rate was 1.19 dilations per patient per year, and the postprocedural dysphagia score (0.72 [95% CI, 0.56-0.87]) was significantly lower than baseline (2.50 [95% CI 2.35-2.65]) (p < 0.001). CONCLUSION Repeated fluoroscopically guided balloon dilation is safe and effective for the management of dysphagia caused by esophageal strictures in DEB. Use of this technique was associated with marked clinical improvement in dysphagia and satisfactory long-term reintervention rates with no major complications.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Lambeth Wing, 1st fl, Westminster Bridge Rd, London SE1 7EH, UK.
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