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Hocar O, Ait Sab I, Akhdari N, Hakkou M, Amal S. A case of pemphigus herpetiformis in a 12-year-old male. ISRN PEDIATRICS 2011; 2011:712560. [PMID: 22389786 PMCID: PMC3263577 DOI: 10.5402/2011/712560] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/16/2011] [Indexed: 11/23/2022]
Abstract
Pemphigus herpetiformis (PH) is one of the less common forms of pemphigus. PH in children is unreported. We describe a case of a child who developed PH. Observation. A 12-year-old boy was seen at our department with erosive plaques, vesicles, and crusted cutaneous lesions associated with severe itching persisting for six months. Histologic examination showed an intraepidermal bulla containing rare acantholytic epidermal cells with eosinophilic spongiosis. Direct immunofluorescence demonstrated intercellular Ig G and C3 deposit. The serum titer of antibodies against intercellular epidermal was 1/200 UI/l. Diagnosis of PH was made, and treatment with Dapsone 2 mg/kg per day resulted in total clinical remission. However, two months later, new vesicles reappeared and treatment was begun with prednisone at a dose of 2 mg/kg daily. There was a very good response. Discussion. Childhood pemphigus herpetiformis is a rare disease, often initially misdiagnosed. It must not be forgotten that the disease is a possible cause of erosive mucocutaneous disease in children.
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Affiliation(s)
- O Hocar
- Dermatology Department, School of Medicine, Cadi Ayyad University, Mohammed the VIth University Hospital Marrakesh, Morocco
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3
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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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4
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Sáenz AM, González F, Cirocco A, Tacaronte IM, Fajardo JE, Calebotta A. Childhood bullous pemphigoid: a case report and 10-year follow up. Int J Dermatol 2007; 46:508-10. [PMID: 17472685 DOI: 10.1111/j.1365-4632.2007.02718.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bullous pemphigoid (BP) is a very rare acquired immunbullous disease in children and infants. We report the case of a 15-month-old boy referred to our service with multiple tense bullae located predominantly on the trunk, neck and proximal portion of the limbs. Palms, soles and oral mucosa were also affected. Histopathologic and immunopathologic features were characterized with bullous pemphigoid. The patient responded well to systemic steroids, with improvement of his condition. After a 10-year follow up the patient was no longer suffering from the disease.
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Affiliation(s)
- Ana María Sáenz
- Department of Dermatology, Hospital Universitario de Caracas, Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela.
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BALDARI U, RACCAGNI AASCARI, CELLI B, RIGHINI MGIOVANNA. Chronic bullous disease of childhood following Epstein-Barr virus seroconversion: a case report. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1996.tb00034.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iamaroon A, Boonyawong P, Klanrit P, Prasongtunskul S, Thongprasom K. Characterization of oral pemphigus vulgaris in Thai patients. J Oral Sci 2006; 48:43-6. [PMID: 16617201 DOI: 10.2334/josnusd.48.43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pemphigus vulgaris (PV) is a serious mucocutaneous disease that be fatal if left untreated. The oral mucosa is often the first site to be affected by the disease. It is thus important that the dentist is able to recognize oral manifestations of PV and refer appropriately. Although oral PV is a well-characterized condition, the disease characteristics of patients in Thailand have not been previously reported. Here, we describe patient and lesion characteristics of 18 cases of oral PV. For these 18 cases, the mean age was 38 years, and the male:female ratio was 1:2. The most commonly affected sites were the gingiva and buccal mucosa, and the duration of disease was approximately one year. Medications previously used included corticosteroids and interferon, and nine patients reported systemic disease. Histopathologic examination with/without direct immunofluorescence was the method of diagnosis in all cases.
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Affiliation(s)
- Anak Iamaroon
- Department of Odontology & Oral Pathology, Faculty of Dentistry, Chiang Mai University, Thailand.
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7
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Bruckner AL, Fitzpatrick JE, Hashimoto T, Weston WL, Morelli JG. Atypical IgA/IgG pemphigus involving the skin, oral mucosa, and colon in a child: a novel variant of IgA pemphigus? Pediatr Dermatol 2005; 22:321-7. [PMID: 16060868 DOI: 10.1111/j.1525-1470.2005.22408.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immune-mediated blistering diseases are rare in childhood, with the subset of IgA pemphigus being extremely uncommon. A child with a bullous disorder of the oral mucosa, skin, and colon is reported because of the unusual nature of the clinical and laboratory findings. Immunofluorescence studies demonstrated both intercellular epidermal and basement membrane zone deposition of IgA and IgG antibodies, as well as intercellular colonic deposition of IgA antibodies. IgA and IgG ELISA tests were positive for desmoglein 3 as the intercellular epidermal antigen. The generation of multiple antibodies against several potential antigenic targets suggests epitope spreading may play a role in this disease. We believe this represents a novel variant of IgA pemphigus.
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Affiliation(s)
- Anna L Bruckner
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
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Affiliation(s)
- Marie Eleanore O Nicolas
- Department of Dermatology and the Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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9
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Parlowsky T, Welzel J, Amagai M, Zillikens D, Wygold T. Neonatal pemphigus vulgaris: IgG4 autoantibodies to desmoglein 3 induce skin blisters in newborns. J Am Acad Dermatol 2003; 48:623-5. [PMID: 12664033 DOI: 10.1067/mjd.2003.170] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of neonatal pemphigus vulgaris presenting with skin lesions on the head, genital area, and right foot. Pemphigus vulgaris was diagnosed by the presence of circulating autoantibodies predominantly of the IgG4 subtype by indirect immunofluorescence microscopy and by enzyme-linked immunosorbent assay using recombinant desmoglein 3. This case demonstrates the pathogenic relevance of IgG4 autoantibodies to desmoglein 3 in the skin of neonates.
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10
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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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11
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Khanna N, Pandhi RK, Gupta S, Singh MK. Response of chronic bullous dermatosis of childhood to a combination of dapsone and nicotinamide. J Eur Acad Dermatol Venereol 2001. [DOI: 10.1046/j.1468-3083.2001.00269-9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Khanna N, Pandhi RK, Gupta S, Singh MK. Response of chronic bullous dermatosis of childhood to a combination of dapsone and nicotinamide. J Eur Acad Dermatol Venereol 2001. [DOI: 10.1046/j.0926-9959.2001.00269-9.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Woollons A, Darley CR, Bhogal BS, Black MM, Atherton DJ. Childhood dermatitis herpetiformis: an unusual presentation. Clin Exp Dermatol 1999; 24:283-5. [PMID: 10457132 DOI: 10.1046/j.1365-2230.1999.00481.x] [Citation(s) in RCA: 14] [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
Childhood dermatitis herpetiformis (DH) is rare. The true prevalence and incidence of this condition are unknown. We report a 7-year-old boy presenting with nonpruritic inflammatory papules on the buttocks and extensor surfaces, clinico-pathologically consistent with Sweet's neutrophilic dermatosis. Immunofluorescence studies showed IgA deposits in the dermal papillae consistent with DH. Remission was achieved with a gluten-free diet and dapsone. Childhood DH may present different clinical signs to the adult form and misdiagnosis can occur if immunofluorescence is not requested on skin biopsy.
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Affiliation(s)
- A Woollons
- Department of Dermatology, Brighton Health Care NHS Trust, Brighton, UK
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14
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Abstract
Immunobullous diseases are quite unusual in children. We report two children who developed immunobullous disease shortly after a second solid organ transplantation. One child had IgA pemphigus vegetans, the other bullous pemphigoid. We hypothesize that the repeat organ transplantation served as a "booster" immunization for autoantibody production. Both children developed their immunobullous condition while being treated with immunosuppressive drugs that are used to treat immunobullous disorders.
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Affiliation(s)
- J G Morelli
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
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15
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Abstract
The incidence of many skin diseases peak in adulthood, and these disorders may be difficult to recognize when they do present in childhood. Their clinical features may be distinct in pediatric patients, and they may be managed differently in children as compared to adults. Therefore, it is important that dermatologists are able to identify "adult" skin disease in the pediatric patient, and know how to appropriately manage these problems in young patients. The epidemiology, clinical features, differential diagnosis, and management of the following "adult" skin diseases in children are reviewed: psoriasis, lichen planus, rosacea, Sweet's syndrome, and mucosis fungoides. Distinctive features of lichen sclerosus and immunobullous diseases in childhood will also be briefly discussed.
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Affiliation(s)
- R Howard
- Division of Pediatric Dermatology, Children's Hospital Oakland, California, USA
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Weston WL, Friednash M, Hashimoto T, Seline P, Huff JC, Morelli JG. A novel childhood pemphigus vegetans variant of intraepidermal neutrophilic IgA dermatosis. J Am Acad Dermatol 1998; 38:635-8. [PMID: 9555810 DOI: 10.1016/s0190-9622(98)70134-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- W L Weston
- Department of Dermatology, University of Colorado School of Medicine, Denver 80262, USA
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17
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Robinson JC, Lozada-Nur F, Frieden I. Oral pemphigus vulgaris: a review of the literature and a report on the management of 12 cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:349-55. [PMID: 9347496 DOI: 10.1016/s1079-2104(97)90030-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Twelve cases of oral pemphigus vulgaris are described to illustrate the long-term behavior of the disease and the treatment challenges it presents to the oral medicine practitioner. In addition, we review the literature on oral pemphigus vulgaris with respect to clinical history, signs and symptoms, management, and treatment outcome. Pemphigus vulgaris is a chronic vesiculobullous disease with a potentially fatal outcome. Mortality from pemphigus vulgaris before the development of effective therapies was as high as 90%. Today, with treatment, it is closer to 10%. Involvement of the oral mucosa is common and in most cases precede skin lesions; in our patients, the oral lesions preceded the development of extraoral disease in 75% of cases. Pemphigus vulgaris was more frequent among women (9:3), and there was a tendency for the severity and frequency of disease to decrease with time.
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Affiliation(s)
- J C Robinson
- Department of Stomatology, University of California, San Francisco, USA
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Abstract
Dermatitis herpetiformis (DH) is seen most commonly as a pruritic, papulovesicular eruption in young children or adolescents. Differentiation from other bullous diseases of childhood may be difficult. We report the first case of an adolescent in whom pruritic, palmar, purpuric macules and papules were the only manifestations of DH. The patient later developed typical vesiculobullous extensor lesions and symptomatic gluten-sensitive enteropathy (GSE). All lesions and GSE symptoms resolved with dapsone and a gluten-free diet. Our purpose is to illustrate an unusual presentation of pediatric DH.
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Affiliation(s)
- T W McGovern
- Dermatology Service, Fitzsimons Army Medical Center, Aurora, Colorado 80045
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