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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Liu SS, Howard T, Fattah YH, Adams A, Hanly AJ, Karai LJ. Lichen Planopilaris Pemphigoides: A Novel Bullous Dermatosis Due to Programmed Cell Death Protein-1 Inhibitor Therapy. Am J Dermatopathol 2023; 45:246-249. [PMID: 36825932 PMCID: PMC10018802 DOI: 10.1097/dad.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Lichen planus pemphigoides (LPPemph), apart from bullous pemphigoid, is a rare bullous dermatosis that can be induced by programmed cell death protein-1 (PD-1)/PD ligand 1 (PD-L1) inhibitors. The primary location of PD-1/PD-L1 inhibitor-induced LPPemph has previously only been reported at the nonfollicular dermal-epidermal junction. We present a case of nivolumab-induced LPPemph with an intense perifollicular lichenoid reaction, prominent multifocal perifollicular clefting, which in addition, was also accompanied by linear IgG and C3 immunofluorescence deposits along the dermal-epidermal junction as well as demonstrating a perifollicular pattern. Intriguingly, the serological study of BP180 and BP230 antibodies was negative, suggesting the presence of additional novel antibodies, which primarily favor hair follicles and may contribute to the pathogenesis. Therefore, we consider this entity a novel variant of PD-1/PD-L1 inhibitor-induced bullous dermatosis. To the best of our knowledge, this is the first report that highlights perifollicular bullae accompanied by immunofluorescence findings in a PD-1/PD-L1 inhibitor-induced lesion. We propose a new immunotherapy associated entity, lichen planopilaris pemphigoides, and emphasize the significance of perifollicular changes in the pathogenesis.
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Affiliation(s)
- Shuo S. Liu
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Tara Howard
- University of Miami, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Yasmin H. Fattah
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Amy Adams
- South Central Dermatology Clinic, Laurel, MS; and
| | | | - Laszlo J. Karai
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Global Pathology, Sonic Healthcare USA, Miami Lakes, FL
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Maggard R, Culton DA, Blake A, Googe P, Miedema J. What is Lichen planus pemphigoides? A highlight of three cases with discussion of differential diagnosis and suggestion of simple classification guidelines. An Bras Dermatol 2023; 98:378-381. [PMID: 36754651 PMCID: PMC10173081 DOI: 10.1016/j.abd.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- Reed Maggard
- University of Washington School of Medicine, Seattle, WA, USA
| | - Donna A Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Blake
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Googe
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jayson Miedema
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Peeters AS, Dhont N, Stals H. Localised childhood vulvar pemphigoid: a rare case study. Facts Views Vis Obgyn 2021; 13:279-282. [PMID: 34555883 PMCID: PMC8823273 DOI: 10.52054/fvvo.13.3.031] [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] [Indexed: 11/14/2022] Open
Abstract
In this case report we present a young patient with localised childhood vulvar pemphigoid. It is a rare variant of bullous pemphigoid with mostly a favourable prognosis and prompt response to potent topical corticosteroids. She presented with relapsing vulvar pain and lesions. Our case enlightens the recognition of this unusual subtype and the importance of performing a cutaneous biopsy.
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Gabusi A, Filippi F, Gissi DB, Loi C, Misciali C, Bardazzi F. Multiple longstanding oral ulcers in an adolescent. Int J Dermatol 2020; 60:e127-e129. [PMID: 32506630 DOI: 10.1111/ijd.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Gabusi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Davide Bartolomeo Gissi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Oral lichen planus pemphigoides: a series of four cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:58-68. [DOI: 10.1016/j.oooo.2015.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 01/09/2023]
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Jang SH, Yun SJ, Lee SC, Lee JB. Lichen planus pemphigoides associated with chronic hepatitis B virus infection. Clin Exp Dermatol 2014; 40:868-71. [PMID: 25546603 DOI: 10.1111/ced.12530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune dermatosis with the features of both lichen planus (LP) and bullous pemphigoid (BP). Although in rare cases, LPP has been associated with several medications and conditions, it is generally considered an idiopathic disorder, and its pathogenesis remains uncertain. We report a 56-year-old woman who presented with a 2-year history of flat-topped, polygonal, violaceous-colored papules and some bullae. She was diagnosed with chronic hepatitis B virus (HBV) infection, which had been treated intermittently with entecavir. Histopathological examination showed the typical features of LP with subepidermal blisters, and with linear deposits of IgG along the basement membrane zone on direct immunofluorescence. Immunoblotting revealed antibodies directed at the BP180 and BP230 antigens. We diagnosed the patient with LPP, and treated the condition with systemic steroids and dapsone. To our knowledge, this is the first report of LPP in a patient with chronic HBV infection.
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Affiliation(s)
- S H Jang
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - S J Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - S C Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - J B Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Sekiya A, Kodera M, Yamaoka T, Iwata Y, Usuda T, Ohzono A, Yasukochi A, Koga H, Ishii N, Hashimoto T. A case of lichen planus pemphigoides with autoantibodies to the NC16a and C-terminal domains of BP180 and to desmoglein-1. Br J Dermatol 2014; 171:1230-5. [PMID: 24813536 DOI: 10.1111/bjd.13097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease that occurs in association with lichen planus (LP). This report describes a 59-year-old Japanese female patient with LPP. The patient first showed LP lesions on her hands, and subsequently developed bullae on her extremities and erosions of the oral mucosa. The patient's serum was positive for IgG autoantibodies against the BP180 NC16a domain, the BP180 C-terminal domain and desmoglein-1. However, a serum sampled one and a half years before the diagnosis of LPP was negative for autoantibodies against BP180 NC16a and BP180 C-terminal domains. These findings strongly suggest that the damage to the basal cells in the LP lesions exposed a sequestered antigen or formed neoantigens, leading to the production of pathogenic autoantibodies for LPP. Most of the previous cases of LPP have produced autoantibodies to the NC16a domain of BP180. This is the first case in which autoantibodies to the C-terminal domain of BP180 were detected. The oral mucosal symptoms in this case may have been caused by autoantibodies to the BP180 C-terminal domain.
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Affiliation(s)
- A Sekiya
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syouwa-ku, Nagoya, Aichi, 4668550, Japan
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Mendoza-Cembranos MD, Campos-Dominguez M, Pulido-Perez A, Conde-Montero E, Parra-Blanco V, Suarez-Fernandez R. Pruritic papular eruption and blisters in a 5-year-old girl. Clin Exp Dermatol 2014; 39:256-8. [PMID: 24382209 DOI: 10.1111/ced.12253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
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Meziane M, Lakjiri S, Harmouch T, Mikou O, Mernissi FZ. Lichen planus pemphigoides in a child. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2014. [DOI: 10.1016/j.jssdds.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Munyangango E, Le Roux-Villet C, Doan S, Pascal F, Soued I, Alexandre M, Heller M, Lièvre N, Aucouturier F, Caux F, Laroche L, Prost-Squarcioni C. Oral cyclophosphamide without corticosteroids to treat mucous membrane pemphigoid. Br J Dermatol 2013; 168:381-90. [DOI: 10.1111/bjd.12041] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Zaraa I, Mahfoudh A, Sellami MK, Chelly I, El Euch D, Zitouna M, Mokni M, Makni S, Osman AB. Lichen planus pemphigoides: four new cases and a review of the literature. Int J Dermatol 2013; 52:406-12. [DOI: 10.1111/j.1365-4632.2012.05693.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Kasperkiewicz M, Zillikens D, Schmidt E. Pemphigoid diseases: Pathogenesis, diagnosis, and treatment. Autoimmunity 2011; 45:55-70. [DOI: 10.3109/08916934.2011.606447] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Le Roux-Villet C. Rituximab for Patients With Refractory Mucous Membrane Pemphigoid. ACTA ACUST UNITED AC 2011; 147:843-9. [DOI: 10.1001/archdermatol.2011.54] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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İLKNUR T, AKARSU S, UZUN S, ÖZER E, FETIL E. Heterogeneous disease: A child case of lichen planus pemphigoides triggered by varicella. J Dermatol 2011; 38:707-10. [DOI: 10.1111/j.1346-8138.2011.01220.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rosmaninho A, Sanches M, Oliveira A, Alves R, Selores M. Lichen planus pemphigoides induced by a weight reduction drug. Cutan Ocul Toxicol 2011; 30:306-8. [PMID: 21428725 DOI: 10.3109/15569527.2011.566234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lichen planus pemphigoides is a rare autoimmune dermatosis characterized by bullous lesions arising on lichen planus (LP) papules and on clinically uninvolved skin, coexistence of histological features of LP and bullous pemphigoid and linear deposits of IgG and/or C3 along the basal membrane zone on direct immunofluorescence of peribullous skin. LPP has been reported to be associated with several medications such as ramipril, cinnarizine, simvastatin, captopril, psoralen ultraviolet A therapy and antituberculous medications. We report a case of a 41-year-old woman with LPP associated with a weight reduction drug.
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Barnadas MA, Roé E, Dalmau J, Alomar A, Martínez L, Gelpí C. Lichen planus pemphigoides: detection of anti-BP 180 antibodies by ELISA and immunoblotting tests. J Eur Acad Dermatol Venereol 2010; 24:1360-1. [PMID: 20337815 DOI: 10.1111/j.1468-3083.2010.03632.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lichen planus pemphigoides, a possible example of epitope spreading. ACTA ACUST UNITED AC 2010; 109:837-43. [DOI: 10.1016/j.tripleo.2009.12.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 12/23/2009] [Accepted: 12/25/2009] [Indexed: 12/28/2022]
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Kolltveit KM, Schreurs O, Østrem J, Søland TM, Khuu C, Berge T, Messelt E, Hayashi K, Granum S, Spurkland A, Schenck K. Expression of the T-cell-specific adapter protein in oral epithelium. Eur J Oral Sci 2010; 118:159-67. [DOI: 10.1111/j.1600-0722.2010.00719.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cohen DM, Ben-Amitai D, Feinmesser M, Zvulunov A. Childhood lichen planus pemphigoides: a case report and review of the literature. Pediatr Dermatol 2009; 26:569-74. [PMID: 19840313 DOI: 10.1111/j.1525-1470.2009.00988.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lichen planus pemphigoides is a rare autoimmune blistering disease that is characterized by evolution of vesico-bullous skin lesions in patients with active lichen planus. We describe a case of lichen planus pemphigoides in a 6-year-old boy and review the clinical and immunopathologic features of all reported cases of pediatric lichen planus pemphigoides. The mean age at onset of childhood lichen planus pemphigoides is 12 years with a male to female ratio of 3:1 and a mean lag-time between lichen planus and the development of lichen planus pemphigoides of 7.9 weeks. Vesiculo-bullous lesions were found on the extremities in all patients and there was palmoplantar involvement in about half of the cases. Direct and indirect immunofluorescence features were similar to those reported in adults. One patient had Western immunoblot data revealing antigens of 180, 230, and 200 kDa. Immunoelectron microscopy in two cases showed localization of immune deposition different from that in bullous pemphigoid. We found that topical corticosteroids or oral dapsone caused resolution of lichen planus pemphigoides without known relapse of blistering in four cases, suggesting that it might be possible to reserve oral corticosteroids as a second line of therapy in children with lichen planus pemphigoides.
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Affiliation(s)
- Daniela M Cohen
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petah-Tiqva, Israel
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Solomon LW, Helm TN, Stevens C, Neiders ME, Kumar V. Clinical and immunopathologic findings in oral lichen planus pemphigoides. ACTA ACUST UNITED AC 2007; 103:808-13. [PMID: 17531940 DOI: 10.1016/j.tripleo.2006.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 03/14/2006] [Accepted: 03/20/2006] [Indexed: 11/26/2022]
Abstract
Lichen planus pemphigoides (LPP) is a rare, acquired, immunobullous disorder of skin that occasionally involves oral mucous membranes. Clinical, histologic, and immunopathologic findings of the oral manifestations of LPP are described. Clinical features are lichenoid striae, erosions, and ulcerations involving gingiva and buccal mucosae. Histopathologic features are similar to those of ora lichen planus. Direct immunofluorescence demonstrates linear deposits of immunoglobulin G and complement component C3 along the basement membrane with fibrillar deposits of fibrin at the epithelial/lamina propria junction. Fluorescence overlay antigen mapping and laser scanning confocal microscopy of the biopsy specimen exhibits colocalization of in situ antibodies with beta4 integrin, a marker of the keratinocyte basal plasma membrane and upper lamina lucida, consistent with the location of the bullous pemphigoid antigens. This case report describes a case of LPP that presented exclusively as an oral condition. Lichen planus pemphigoides should be considered in the clinical differential diagnosis of vesiculoerosive oral mucosal diseases.
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Affiliation(s)
- Lynn W Solomon
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, New York 14214, USA.
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Campos-Domínguez M, Silvente C, de la Cueva P, González-Carrascosa M, Lecona M, Suárez R, Lázaro P. [Erythrodermic lichen planus pemphigoides]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:583-6. [PMID: 17173763 DOI: 10.1016/s0001-7310(06)73471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lichen planus pemphigoides is a clinico-histological subtype of lichen planus in which there are bullous lesions similar to those of bullous pemphigoid. Lichen planus is included among the rare causes of erythroderma. We present a case of erythrodermic lichen planus pemphigoides in a 49-year-old female patient who satisfactorily responded to treatment with cyclosporine. A detailed physical examination and immunofluorescence study are key to the diagnosis of lichen planus pemphigoides.
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Affiliation(s)
- M Campos-Domínguez
- Servicio de Dermatología, Unidad de Enfermedades Ampollosas, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007 Madrid, Spain.
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Sakuma-Oyama Y, Powell AM, Albert S, Oyama N, Bhogal BS, Black MM. Lichen planus pemphigoides evolving into pemphigoid nodularis. Clin Exp Dermatol 2003; 28:613-6. [PMID: 14616828 DOI: 10.1046/j.1365-2230.2003.01401.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen planus pemphigoides (LPP) and pemphigoid nodularis are rare clinical variants of bullous pemphigoid (BP), which are characterized by histological findings of lichen planus (LP) and nodular prurigo, respectively, and the finding of linear deposits of IgG and/or C3 at the basement membrane zone in perilesional skin. In both cases bullae may arise at the site of pre-existing LP-like or nodular prurigo-like eruptions, and clinically uninvolved skin. The disease spectrum of LPP and pemphigoid nodularis differs from that of classical BP phenotype, and their presentations are often indolent. LPP may predominantly affect a younger age group and is responsive to standard treatments used in acquired autoimmune bullous diseases, while pemphigoid nodularis is more common in elderly women and is relatively resistant to therapy. We describe a patient who had LPP for nearly two decades and subsequently developed a nodular eruption with a concurrently detected antibullous pemphigoid antigen 2 (BP180) autoantibody. His overall clinicopathological features were indicative of LPP evolving into another BP variant, pemphigoid nodularis.
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Affiliation(s)
- Y Sakuma-Oyama
- Department of Dermato-immunopathology, St. John's Institute of Dermatology, Guy's, King's and St. Thomas' School of Medicine, St Thomas' Hospital (KCL), London, UK.
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Affiliation(s)
- Z Demirçay
- Department of Dermatology, Marmara University School of Medicine, Turkey.
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Abstract
A 72-year-old woman had suffered from parapsoriasis en plaque (large plaque type) controlled by topically applied psoralen ultraviolet A (PUVA) therapy. The parapsoriasis lesions gradually disappeared, but numerous tiny red papules with pruritus appeared over the forearms and lower legs 120 days after starting PUVA therapy. These papules developed to form violaceous plaques. Histological findings demonstrated the characteristics of lichen planus. Two months later, tense bullae developed on the plaques and on uninvolved skin of the limbs. These were subepidermal, with linear deposits of IgG and C3 along the basement membrane zone (BMZ) in immunofluorescence of peribullous skin, and immunodeposits of type IV collagen along the floor of the bullae. We therefore, diagnosed lichen planus pemphigoides (LPP). Using systemic and topical steroid therapy, the lesions rapidly resolved and there has been no recurrence. This case suggests that the combination of basal cell injuries caused by chronic inflammation and PUVA therapy could expose BMZ components to autoreactive lymphocytes and induce LPP.
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Affiliation(s)
- N Kuramoto
- Department of Dermatology, Kyoto Prefectual University of Medicine, 465 Hirokoji, Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan.
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Zillikens D, Caux F, Mascaro JM, Wesselmann U, Schmidt E, Prost C, Callen JP, Bröcker EB, Diaz LA, Giudice GJ. Autoantibodies in lichen planus pemphigoides react with a novel epitope within the C-terminal NC16A domain of BP180. J Invest Dermatol 1999; 113:117-21. [PMID: 10417629 DOI: 10.1046/j.1523-1747.1999.00618.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen planus pemphigoides is an autoimmune subepidermal blistering disease. The finding of immunoglobulin G antibodies directed against the basement membrane zone differentiates it from bullous lichen planus. The aim of this study was to identify the target antigen of lichen planus pemphigoides autoantibodies. Sera from lichen planus pemphigoides patients (n = 4) stained the epidermal side of NaCl-split human skin in a pattern indistinguishable from that produced by bullous pemphigoid sera. In bullous pemphigoid, the autoimmune response is directed against BP180, a hemidesmosomal transmembrane collagenous glycoprotein. We previously demonstrated that bullous pemphigoid sera predominantly react with a set of four epitopes (MCW-0 through MCW-3) clustered within a 45 amino acid stretch of the major noncollagenous extracellular domain (NC16A) of BP180. By immunoblotting and enzyme-linked immunosorbent assay, lichen planus pemphigoides sera were also strongly reactive with recombinant bullous pemphigoid 180 NC16A. The lichen planus pemphigoides epitopes were further mapped using a series of overlapping recombinant segments of the NC16A domain. All lichen planus pemphigoides sera reacted with amino acids 46-59 of domain NC16A, a protein segment that was previously shown to be unreactive with bullous pemphigoid sera. Two lichen planus pemphigoides sera, in addition, reacted with the immunodominant antigenic region associated with bullous pemphigoid. In conclusion, there are now five bullous diseases that are associated with an autoimmune response to BP180: bullous pemphigoid; pemphigoid/herpes gestationis; cicatricial pemphigoid; linear immunoglobulin A disease; and lichen planus pemphigoides. In addition, we have identified a novel epitope within the BP180 NC16A domain, designated MCW-4, that appears to be uniquely recognized by sera from patients with lichen planus pemphigoides.
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Affiliation(s)
- D Zillikens
- Department of Dermatology, University of Würzburg, Germany
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Schumann H, Amann U, Tasanen K, Müller S, Zillikens D, Metze D, Luger T, Bruckner-Tuderman L, Bonsmann G. A child with localized vulval pemphigoid and IgG autoantibodies targeting the C-terminus of collagen XVII/BP180. Br J Dermatol 1999; 140:1133-8. [PMID: 10354084 DOI: 10.1046/j.1365-2133.1999.02891.x] [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: 11/20/2022]
Abstract
Localized vulval pemphigoid of childhood (LVPC) has previously been reported in six girls. Clinical features and immunopathological data have suggested it to be a morphological variant of bullous pemphigoid. Epitope targets of the autoantibodies of these patients have not been defined in detail. We describe a 9-year-old girl with possible cicatricial LVPC and circulating IgG antibodies directed against native collagen XVII/BP180, its 120-kDa soluble ectodomain and against the C-terminus of collagen XVII/BP180. No reactivity was detected towards the NC16A domain of collagen XVII/BP180. Linear IgG and C3 deposits were found along the cutaneous basement membrane zone. On 1 mol/L salt-split skin, IgG autoantibodies were shown to bind to the epidermis, and the HLA type II allele DQB1*0301, a marker with significantly increased occurrence in patients with ocular and oral cicatricial pemphigoid, was identified in this patient. Our data suggest that LVPC is a variant of bullous pemphigoid in which direct immunofluorescence microscopy combined with immunoblot analysis can deliver valuable diagnostic information for differential diagnosis. However, differentiation between the scarring and non-scarring course of the disease cannot be made with the present diagnostic markers and therefore careful follow-up of patients with LVPC is required.
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Affiliation(s)
- H Schumann
- University of Münster, D-48149 Münster, Germany.
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Abstract
The hemidesmosome is a membrane-associated supramolecular dermal epidermal complex linking the cytoskeleton of the basal keratinocyte to structures within the papillary dermis. Different components of this complex have been identified as autoantigens in autoimmune bullous skin diseases. Some of the autoantigens have been characterized at the molecular level. Little is known, however, about the factors that initiate the production of autoantibodies. By histopathology, acquired skin diseases of hemidesmosomes show subepidermal blisters and by direct immunofluorescence, linear deposits of IgG, C3 or IgA at the dermal epidermal junction. Bullous pemphigoid (BP) is the most common acquired disease of hemidesmosomes. Two proteins, BP180 and BP230, have been identified as primary targets of autoantibodies in BP. In addition, pemphigoid/herpes gestationis, lichen planus pemphigoides, cicatricial pemphigoid and linear IgA disease are characterized by an immune response to BP180. Laminin 5 is another well-characterized anchoring filament-lamina densa component of hemidesmosomes. Patients with autoantibodies to laminin 5 show the clinical phenotype of cicatricial pemphigoid. Other acquired skin diseases of the hemidesmosomes reveal autoantibodies to a plectin-like protein, the beta4 subunit of alpha6beta4 integrin, uncein and a not yet characterized 168 kDa protein. Recently, diseases with autoantibodies to 105 and 200 kDa proteins of the lower lamina lucida have been reported. The association of these autoantigens with hemidesmosomes still needs to be demonstrated. Finally, anchoring fibrils associate with the dermal epidermal anchoring complex. The major structural component of anchoring fibrils is type VII collagen, the autoantigen of epidermolysis bullosa acquisita.
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Affiliation(s)
- D Zillikens
- Department of Dermatology, University of Würzburg, Germany.
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