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Abstract
Hailey-Hailey disease is a rare blistering dermatosis first described in 1939 by the brothers Howard and Hugh Hailey. Its incidence is estimated at 1/50,000. The inheritance is autosomal dominant with complete penetrance, but a variable expressivity in affected family members. Clinically, Hailey-Hailey disease presents between the third and fourth decade as flaccid vesicles and blisters on erythematous skin, giving rise to erosions, fissures, and vegetations. Maceration and superinfections are frequent. The lesions are typically distributed symmetrically within intertriginous regions such as the retroauricular folds, lateral aspects of the neck, axillae, umbilicus, inguinal, and perianal regions. The disease is characterized by a chronic relapsing course with spontaneous remissions and multiple recurrences. Severe disease can be very frustrating and have a major psychological and social impact. Given the dearth of evidence-based guidelines and large clinical trials, the assessment of the efficacy and safety of treatments is difficult. Treatments include topical and systemic agents, and procedural therapy such as lasers and surgery. This review provides a systematic search of the literature with a focus on classical and emerging treatment options for Hailey-Hailey disease.
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Megna M, Scalvenzi M, Russo D, Timoshchuk EA, Costa C, Santoianni P. Hailey-Hailey disease successfully treated with vitamin D oral supplementation. Dermatol Ther 2018; 32:e12767. [PMID: 30291662 DOI: 10.1111/dth.12767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 03/19/2018] [Accepted: 09/29/2018] [Indexed: 01/10/2023]
Abstract
Hailey-Hailey disease (HHD) also known as familial benign chronic pemphigus is a rare autosomal dominant genodermatosis. HHD treatment is often not satisfactory and hence, various modalities of treatment have been tried. We describe the case of a 37-year-old woman with a 2 years history of macerated erythematous plaques along with erosions, fissures, and crusts located on axillae and submammary areas, successfully treated with only oral supplementation of vitamin D (800 I.U./die) for 3 months. We reported this case to suggest that oral vitamin D may be enumerated in the various treatments proposed for HHD so far due to its rapid efficacy on skin lesions and symptoms.
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Affiliation(s)
- Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology section, University of Naples Federico II, Naples, Italy
| | - Elena A Timoshchuk
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Claudia Costa
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Pietro Santoianni
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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Arora H, Bray FN, Cervantes J, Falto Aizpurua LA. Management of familial benign chronic pemphigus. Clin Cosmet Investig Dermatol 2016; 9:281-290. [PMID: 27695354 PMCID: PMC5027951 DOI: 10.2147/ccid.s89483] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Benign familial chronic pemphigus or Hailey-Hailey disease is caused by an autosomal dominant mutation in the ATP2C1 gene leading to suprabasilar acantholysis. The disease most commonly affects intertriginous areas symmetrically. The chronic nature of the disease and multiple recurrences make the disease bothersome for patients and a treatment challenge for physicians. Treatments include topical and/or systemic agents and surgery including laser. This review summarizes the available treatment options.
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Affiliation(s)
- Harleen Arora
- Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Fleta N Bray
- Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Leyre A Falto Aizpurua
- Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
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Tukaj S, Grüner D, Tukaj C, Zillikens D, Kasperkiewicz M. Calcitriol exerts anti-inflammatory effects in keratinocytes treated with autoantibodies from a patient with bullous pemphigoid. J Eur Acad Dermatol Venereol 2015; 30:288-92. [PMID: 25610950 DOI: 10.1111/jdv.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The hormonally active vitamin D metabolite calcitriol and its analogues exert potent effects on cellular differentiation and regulation of immune responses. Although topical vitamin D analogues are widely used for treatment of psoriasis and vitamin D has been increasingly implicated in prevention and protection from several autoimmune diseases, experimental and clinical data in autoimmune bullous diseases are generally lacking. OBJECTIVE Here, we investigated the effects of calcitriol on keratinocytes treated by bullous pemphigoid (BP) autoantibodies. METHODS Human keratinocyte (HaCaT) cells were treated with purified human BP or normal IgG from one BP patient and healthy subject, respectively, in the absence or presence of calcitriol and effects on (i) cell viability, (ii) IL-6 and IL-8 secretion, (iii) STAT3 and NFκB activation, (iv) heat shock protein 70 (Hsp70) level, and (v) vitamin D receptor (VDR) expression were studied. RESULTS We found that BP IgG-induced IL-6 and IL-8 release from HaCaT cells was reduced in the presence of non-toxic doses of calcitriol. Additionally, calcitriol blunted BP IgG-mediated STAT3 phosphorylation and NFκB activity, whereas Hsp70 and VDR expression were not affected. CONCLUSION Although the results of this study are based on autoantibodies prepared from a single patient, they show that calcitriol protects from BP IgG-induced inflammatory processes in vitro, thus favouring its potential inclusion into the therapeutic repertoire of BP.
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Affiliation(s)
- S Tukaj
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D Grüner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - C Tukaj
- Department of Electron Microscopy, Medical University of Gdańsk, Gdańsk, Poland
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M Kasperkiewicz
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Abstract
BACKGROUND Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. OBJECTIVE The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. METHODS A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. RESULTS A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. CONCLUSION Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
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Voisset C, García-Rodríguez N, Birkmire A, Blondel M, Wellinger RE. Using yeast to model calcium-related diseases: example of the Hailey-Hailey disease. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2014; 1843:2315-21. [PMID: 24583118 DOI: 10.1016/j.bbamcr.2014.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/25/2014] [Accepted: 02/16/2014] [Indexed: 02/05/2023]
Abstract
Cross-complementation studies offer the possibility to overcome limitations imposed by the inherent complexity of multicellular organisms in the study of human diseases, by taking advantage of simpler model organisms like the budding yeast Saccharomyces cerevisiae. This review deals with, (1) the use of S. cerevisiae as a model organism to study human diseases, (2) yeast-based screening systems for the detection of disease modifiers, (3) Hailey-Hailey as an example of a calcium-related disease, and (4) the presentation of a yeast-based model to search for chemical modifiers of Hailey-Hailey disease. The preliminary experimental data presented and discussed here show that it is possible to use yeast as a model system for Hailey-Hailey disease and suggest that in all likelihood, yeast has the potential to reveal candidate drugs for the treatment of this disorder. This article is part of a Special Issue entitled: Calcium signaling in health and disease. Guest Editors: Geert Bultynck, Jacques Haiech, Claus W. Heizmann, Joachim Krebs, and Marc Moreau.
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Affiliation(s)
- Cécile Voisset
- Institut National de la Santé et de la Recherche Médicale UMR 1078; Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé; Etablissement Français du Sang (EFS) Bretagne; CHRU Brest, Hôpital Morvan, Laboratoire de Génétique Moléculaire, Brest F-29200, France
| | - Néstor García-Rodríguez
- Andalusian Center of Molecular Biology and Regenerative Medicine (CABIMER), University of Seville, Avd. Americo Vespucio SN, 41092 Sevilla, Spain
| | - April Birkmire
- Andalusian Center of Molecular Biology and Regenerative Medicine (CABIMER), University of Seville, Avd. Americo Vespucio SN, 41092 Sevilla, Spain
| | - Marc Blondel
- Institut National de la Santé et de la Recherche Médicale UMR 1078; Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé; Etablissement Français du Sang (EFS) Bretagne; CHRU Brest, Hôpital Morvan, Laboratoire de Génétique Moléculaire, Brest F-29200, France.
| | - Ralf Erik Wellinger
- Andalusian Center of Molecular Biology and Regenerative Medicine (CABIMER), University of Seville, Avd. Americo Vespucio SN, 41092 Sevilla, Spain
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Jeon SY, Ha SM, Ko DY, Song KH, Kim KH. Hailey-hailey disease treated with topical tacalcitol. Ann Dermatol 2013; 25:389-90. [PMID: 24003293 PMCID: PMC3756215 DOI: 10.5021/ad.2013.25.3.389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/14/2022] Open
Affiliation(s)
- Su-Young Jeon
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
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Hobbs RP, Amargo EV, Somasundaram A, Simpson CL, Prakriya M, Denning MF, Green KJ. The calcium ATPase SERCA2 regulates desmoplakin dynamics and intercellular adhesive strength through modulation of PKCα signaling. FASEB J 2010; 25:990-1001. [PMID: 21156808 DOI: 10.1096/fj.10-163261] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Darier's disease (DD) is an inherited autosomal-dominant skin disorder characterized histologically by loss of adhesion between keratinocytes. DD is typically caused by mutations in sarcoendoplasmic reticulum Ca(2+)-ATPase isoform 2 (SERCA2), a major regulator of intracellular Ca(2+) homeostasis in the skin. However, a defined role for SERCA2 in regulating intercellular adhesion remains poorly understood. We found that diminution of SERCA2 function by pharmacological inhibition or siRNA silencing in multiple human epidermal-derived cell lines was sufficient to disrupt desmosome assembly and weaken intercellular adhesive strength. Specifically, SERCA2-deficient cells exhibited up to a 60% reduction in border translocation of desmoplakin (DP), the desmosomal cytolinker protein necessary for intermediate filament (IF) anchorage to sites of robust cell-cell adhesion. In addition, loss of SERCA2 impaired the membrane translocation of protein kinase C α (PKCα), a known regulator of DP-IF association and desmosome assembly, to the plasma membrane by up to 70%. Exogenous activation of PKCα in SERCA2-deficient cells was sufficient to rescue the defective DP localization, desmosome assembly, and intercellular adhesive strength to levels comparable to controls. Our findings indicate that SERCA2-deficiency is sufficient to impede desmosome assembly and weaken intercellular adhesive strength via a PKCα-dependent mechanism, implicating SERCA2 as a novel regulator of PKCα signaling.
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Affiliation(s)
- Ryan P Hobbs
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Lee GH, Kim YM, Lee SY, Lee JS, Park YL, Whang KU. A case of eczema herpeticum with hailey-hailey disease. Ann Dermatol 2009; 21:311-4. [PMID: 20523813 DOI: 10.5021/ad.2009.21.3.311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 02/22/2009] [Indexed: 11/08/2022] Open
Abstract
Eczema herpeticum is the dissemination of herpes simplex virus in the setting of a preexisting skin disease. Hailey-Hailey disease [familial benign chronic pemphigus] is a blistering dermatosis that is inherited as an autosomal dominant trait and it usually presents itself around the third or fourth decades. Coexistence of eczema herpeticum and Hailey-Hailey disease is an infrequent occurrence. Four such cases have been reported in the English and German medical literature. We report here on an unusual case of eczema herpeticum that coexisted with Hailey-Hailey disease in a 47 years old man and we review the relevant literatures.
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Affiliation(s)
- Gun Hong Lee
- Department of Dermatology, Soonchunhyang University College of Medicine, Seoul, Korea
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Affiliation(s)
- Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
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Hurd DS, Johnston C, Bevins A. A case report of Hailey-Hailey disease treated with alefacept (Amevive). Br J Dermatol 2007; 158:399-401. [PMID: 17941942 DOI: 10.1111/j.1365-2133.2007.08248.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hailey-Hailey disease (chronic benign familial pemphigus) is a chronic, recurrent blistering disorder characterized clinically by erosions occurring primarily in intertriginous regions and histologically by suprabasilar acantholysis. We report a case of Hailey-Hailey disease initially unresponsive to multiple topical corticosteroids, tetracycline, dapsone, ciclosporin, isotretinoin, prednisone, methotrexate, topical ciclopirox, tazarotene cream, pimecrolimus cream and tacrolimus ointment. Partial response of this patient's perineal disease was achieved with Amevive 15 mg weekly for 12 weeks, intramuscularly. To our knowledge, this case represents the first such published report of successful treatment of Hailey-Hailey disease using alefacept.
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Affiliation(s)
- D S Hurd
- Department of Dermatology, Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, USA.
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Bianchi L, Chimenti MS, Giunta A. Treatment of Hailey-Hailey disease with topical calcitriol. J Am Acad Dermatol 2004; 51:475-6. [PMID: 15337998 DOI: 10.1016/j.jaad.2003.10.668] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Norman AW, Silva FR. Structure function studies: identification of vitamin D analogs for the ligand-binding domains of important proteins in the vitamin D-endocrine system. Rev Endocr Metab Disord 2001; 2:229-38. [PMID: 11705328 DOI: 10.1023/a:1010067030049] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A W Norman
- Department of Biochemistry, Division of Biomedical Sciences, University of California, Riverside, CA 92521, USA.
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Lapiere JC, Hirsh A, Gordon KB, Cook B, Montalvo A. Botulinum toxin type A for the treatment of axillary Hailey-Hailey disease. Dermatol Surg 2000; 26:371-4. [PMID: 10759827 DOI: 10.1046/j.1524-4725.2000.99278.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hailey-Hailey disease is an inherited acantholytic disorder affecting the intertriginous areas of the body which is exacerbated by sweat, moisture, and friction. The disease is frequently resistant to conventional nonsurgical treatment. OBJECTIVE To evaluate whether chemodenervation of sweat glands would improve the course of the disease in a patient with Hailey-Hailey. METHODS We used low-dose treatment of the left axilla with botulinum toxin type A, the right axilla being used as a control, followed by treatment of both axillae with the optimal dose routinely used for the treatment of axillary hyperhidrosis. RESULTS After one treatment with a low dose of botulinum toxin type A, we observed partial improvement of the treated axilla. With subsequent treatment of both axillae with the recommended dose for axillary hyperhidrosis, we observed a sustained complete remission of the disease in the treated axillae. CONCLUSION Botulinum toxin type A may be an effective and safe nonsurgical alternative for the treatment of benign familial pemphigus in intertriginous areas such as the axillae.
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Affiliation(s)
- J C Lapiere
- Department of Dermatology, Northwestern University Medical School, Chicago, Illinois, USA.
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Verstuyf A, Segaert S, Verlinden L, Bouillon R, Mathieu C. Recent developments in the use of vitamin D analogues. Expert Opin Investig Drugs 2000; 9:443-55. [PMID: 11060686 DOI: 10.1517/13543784.9.3.443] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The non-classical effects of 1alpha,25-dihydroxyvitamin D(3) (1alpha, 25(OH)(2)D(3)) create possible therapeutic applications for immune modulation (e.g., autoimmune diseases and graft rejection), inhibition of cell proliferation (e.g., psoriasis, cancer) and induction of cell differentiation (e.g., cancer). The major drawback related to the use of 1alpha,25(OH)(2)D(3) is its calcaemic effect, which prevents the application of pharmacological concentrations. Intensive research has led to the development of analogues of 1(2)D(3) characterised by a clear dissociation of the antiproliferative and prodifferentiating capacity from the calcaemic effects. Due to this dissociation, these analogues can be used not only for the treatment of bone disorders but also for non-classical applications. In the present review, a summary is given on the use of the 1alpha,25(OH)(2)D(3) analogues for the treatment of cancer, skin and immune disorders and for the prevention of graft rejection. Moreover a brief overview is given on the use of analogues for secondary hyperparathyroidism.
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Affiliation(s)
- A Verstuyf
- Laboratorium voor Experimentele Geneeskunde en Endocrinologie (LEGENDO),UZ Gasthuisberg, Onderwijs en Navorsing, Herestraat 49, 3000 Leuven, Belgium
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