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Moro F, Sinagra JLM, Salemme A, Fania L, Mariotti F, Pira A, Didona B, Di Zenzo G. Pemphigus: trigger and predisposing factors. Front Med (Lausanne) 2023; 10:1326359. [PMID: 38213911 PMCID: PMC10783816 DOI: 10.3389/fmed.2023.1326359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
Pemphigus is a life-threatening autoimmune blistering disease affecting skin and mucous membranes. Despite its etiopathogenesis remains largely unknown, several trigger and predisposing factors have been reported. Pemphigus is caused by autoantibodies that target desmoglein 1 and desmoglein 3, impacting desmosome function. However, circulating autoantibodies are often the consequence of a precipitating factor that occurs in predisposed individuals. This review aims to describe and discuss almost all trigger and predisposing factors reported as possible or probable cause of the disease. Among the reported trigger factors that may induce or exacerbate pemphigus, we have found of particular interest: drug intake (especially thiol- and phenol-containing compounds), vaccines, infections, as well as some reports about pregnancy, radiations, emotional stress, pesticides and physical trauma. Moreover, we discuss the possible role of food intake in pemphigus onset and particular attention is given to dietary factors containing thiol, phenol and tannin compounds. A trigger factor is "the straw that breaks the camel's back," and often acts together with predisposing factors. Here we discuss how pemphigus onset may be influenced by genetic susceptibility and comorbidities like thyroid diseases, malignancies and other autoimmune disorders. To identify other hitherto unknown trigger and predisposing factors, well designed prospective studies are needed. In this context, future research should explore their connection with the aim to advance our understanding of pemphigus pathogenesis.
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Affiliation(s)
- Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Jo Linda Maria Sinagra
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Adele Salemme
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Luca Fania
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Anna Pira
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Diseases Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
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Rasner CJ, Schultz B, Bohjanen K, Pearson DR. Autoimmune bullous disorder flares following severe acute respiratory syndrome coronavirus 2 vaccination: a case series. J Med Case Rep 2023; 17:408. [PMID: 37749657 PMCID: PMC10521391 DOI: 10.1186/s13256-023-04146-y] [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] [Received: 02/14/2023] [Accepted: 08/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Autoimmune bullous disorders develop due to autoantibodies targeting intercellular adhesion proteins of hemidesmosomes and desmosomes and may be triggered by viral infections and vaccines. Recent reports suggest that the coronavirus disease 2019 vaccination may trigger flares or exacerbations of preexisting autoimmune diseases, including new onset autoimmune bullous disorders. There are less data on whether vaccination against severe acute respiratory syndrome coronavirus 2 may also exacerbate preexisting autoimmune bullous disorders. CASE PRESENTATION Here we present three cases, two white males (ages 69 years and 88 years) with bullous pemphigoid and one white 50-year-old female with pemphigus foliaceus, wherein all individuals developed minor, tractable flares of their preexisting autoimmune bullous disorders after receiving the coronavirus disease 2019 vaccination, which were readily treatable with topical or low-dose systemic corticosteroids. CONCLUSIONS Dermatologists managing patients with autoimmune bullous disorders should be cognizant of the uncommon potential for flares of the disorder following vaccination for severe acute respiratory syndrome coronavirus 2. Flares of bullous pemphigoid and pemphigus foliaceus following vaccination for severe acute respiratory syndrome coronavirus 2 in these cases were mild and tractable.
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Affiliation(s)
- Cody J Rasner
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Brittney Schultz
- University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, MMC 98, Minneapolis, MN, 55455, USA
| | - Kimberly Bohjanen
- University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, MMC 98, Minneapolis, MN, 55455, USA
| | - David R Pearson
- University of Minnesota Medical School, Minneapolis, MN, USA.
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, MMC 98, Minneapolis, MN, 55455, USA.
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Al Bshabshe A, Mousa WF, Nor El-Dein N. An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of? Diagnostics (Basel) 2023; 13:1290. [PMID: 37046508 PMCID: PMC10093365 DOI: 10.3390/diagnostics13071290] [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: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Medicine/Adult Critical Care, King Khalid University, Abha 61413, Saudi Arabia
| | - Wesam F. Mousa
- College of Medicine, Tanta University, Tanta 31512, Egypt
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Gau SY, Hsiao YP, Liao WC, Ma KSK, Wu MC. Risk of liver dysfunction and non-alcoholic fatty liver diseases in people with hidradenitis suppurativa: A systematic review and meta-analysis of real-world evidences. Front Immunol 2022; 13:959691. [PMID: 36591267 PMCID: PMC9794989 DOI: 10.3389/fimmu.2022.959691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background To date, evidences with high evidence-level evaluating the association between liver diseases and hidradenitis suppurativa was lacking. Given that inconsistency exists in some of the previous observational studies, evaluating the prevalence of liver diseases in HS patients could potentially serve as a reference of future guidelines for HS comorbidity screening. The aim of the current study was to evaluate potential association between hidradenitis suppurativa and liver diseases and provide integrated evidences. Methods A search in PubMed, Web of Science and Embase based on the syntaxes ''hidradenitis suppurativa'' or ''acne inversa'' with "comorbidities", "liver diseases", "fatty liver" or "hepatitis" was performed. Observational studies evaluating epidemiological association between hidradenitis suppurativa and the risk of all liver diseases, including specific diseases as non-alcoholic fatty liver disease, hepatitis B, hepatitis C were targeted to be extracted in this systematic review and meta-analysis. Results Within the initial 702 records, there were finally 8 real-world observational studies extracted. Results suggest that patients with HS are associated with all liver diseases (OR= 1.50; 95% CI, 1.27, 1.76), non-alcoholic fatty liver disease (OR= 1.78; 95% CI, 1.28, 2.48) and hepatitis B (OR=1.48; 95% CI, 1.12, 1.94), but not hepatitis C (OR= 1.27; 95% CI, 0.78, 2.07). HS patients were associated with significantly increased risk of liver diseases, especially the risk of non-alcoholic fatty liver disease and hepatitis B. Conclusions Clinicians should be alert to the clinical relationship while caring people with hidradenitis suppurativa and the screening of liver function should be recommended to HS patients. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022296034.
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Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan,Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan,Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chieh Liao
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States,Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Meng-Che Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Division of Gastroenterology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan,*Correspondence: Meng-Che Wu,
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Biondo MI, Fiorentino C, Persechino S, Tammaro A, Koverech A, Bartolazzi A, Raffa S, Canzoni M, Picchianti-Diamanti A, Di Rosa R, Di Zenzo G, Scala E, Meneguzzi G, Ferlito C, Markovic M, Caporuscio S, Sorgi ML, Salemi S, Laganà B. May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature. Microorganisms 2021; 9:microorganisms9061235. [PMID: 34200214 PMCID: PMC8229970 DOI: 10.3390/microorganisms9061235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for severe erythematosus blistering disease, accompanied by hyper-eosinophilia and hyper-IgE. The culture of bullous fluid was positive for Enterococcus faecalis, the blood culture was positive for Staphylococcus aureus, and the urine culture was positive for Proteus mirabilis and Escherichia coli. Moreover, circulating anti-BP180 IgG was present and the histopathological/ultrastructural examination of a lesional skin biopsy was compatible with BP. High eosinophil levels (up to 3170/µL) were found throughout the clinical course, while values below 1000/µL were associated with clinical improvement. The total IgE was 1273 IU/mL, and specific anti-G/V-penicillin/ampicillin IgE antibodies were positive. The patient had a complete clinical recovery in two months with methyl-prednisolone (40 then 20 mg/day) and low-dose azathioprine (50 mg/day) as a steroid-sparing agent. The steroid treatment was tapered until interruption during a one-year period and intravenous immunoglobulins have been administered for three years in order for azathioprine to also be interrupted. The patient stopped any treatment five years ago and, in this period, has always been in good health. In this case, the contemporaneous onset of different bacterial infections and BP is suggestive of bacterial infections acting as BP trigger(s), with allergic and autoimmune pathways contributing to the disease pathogenesis.
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Affiliation(s)
- Michela Ileen Biondo
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Chiara Fiorentino
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Severino Persechino
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Antonella Tammaro
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Angela Koverech
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Armando Bartolazzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Salvatore Raffa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Marco Canzoni
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Andrea Picchianti-Diamanti
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Roberta Di Rosa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Giovanni Di Zenzo
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Enrico Scala
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Giorgia Meneguzzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Claudia Ferlito
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Milica Markovic
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Sara Caporuscio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Maria Laura Sorgi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Simonetta Salemi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
| | - Bruno Laganà
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
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Chou CYT, Lin CW, Chen GS, Huang RY. Mucous membrane pemphigoid in a patient with chronic hepatitis B virus infection: A case report. Medicine (Baltimore) 2021; 100:e25955. [PMID: 34011077 PMCID: PMC8137072 DOI: 10.1097/md.0000000000025955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Mucous membrane pemphigoid (MMP) is a rare, autoimmune bullous disease that affects mucosal surfaces and skin. Early and aggressive treatment initiation may be warranted due to the risks of serious complications. However, it can be challenging to make an initial diagnosis. Viral infection such as hepatitis B virus (HBV) infection has been found to be associated with the formation of autoimmune bullous diseases. PATIENT CONCERNS The patient was a 43-year-old male with gingivitis and recurrent swelling over the neck, cheeks, lips, and eyelids. The patient presented at oral medicine, otolaryngology, plastic surgery, and ophthalmology sequentially, and was later referred to the rheumatology, dermatology, and family medicine departments. Recurrent hemorrhagic bullae on oral mucosa and skin scarring occurred 2 years after the onset of the initial symptoms. DIAGNOSIS Skin biopsy with direct immunofluorescence was performed under the suspicion of MMP. Lesional hematoxylin and eosin stain and perilesional direct immunofluorescence were consistent with MMP. INTERVENTIONS Systemic Prednisolone and topical corticosteroid were used to control the disease. OUTCOMES A flare-up of hepatitis B developed as a result of systemic prednisolone use. The disease went through relapses and remissions. The patient is on low-dose prednisolone (5 mg/day) with a monthly outpatient visit in the family medicine department. LESSONS It would be useful for medical practitioners in different specialties to be alert of the heterogeneous presentations of MMP. Chronic HBV infection might be a risk factor for MMP. In patients with chronic HBV infection, treatment of MMP must be closely monitored for the risk of reactivation of HBV.
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Affiliation(s)
| | - Chi-Wei Lin
- Department of Family and Community Medicine, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou Univeristy
| | - Gwo-Shing Chen
- Department of Dermatology, Kaohsiung Medical University Hospital
- Department of Dermatology, E-Da Hospital, Kaohsiung, Taiwan
| | - Ru-Yi Huang
- Department of Family and Community Medicine, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou Univeristy
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Moro F, Fania L, Sinagra JLM, Salemme A, Di Zenzo G. Bullous Pemphigoid: Trigger and Predisposing Factors. Biomolecules 2020; 10:E1432. [PMID: 33050407 PMCID: PMC7600534 DOI: 10.3390/biom10101432] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Bullous pemphigoid (BP) is the most frequent autoimmune subepidermal blistering disease provoked by autoantibodies directed against two hemidesmosomal proteins: BP180 and BP230. Its pathogenesis depends on the interaction between predisposing factors, such as human leukocyte antigen (HLA) genes, comorbidities, aging, and trigger factors. Several trigger factors, such as drugs, thermal or electrical burns, surgical procedures, trauma, ultraviolet irradiation, radiotherapy, chemical preparations, transplants, and infections may induce or exacerbate BP disease. Identification of predisposing and trigger factors can increase the understanding of BP pathogenesis. Furthermore, an accurate anamnesis focused on the recognition of a possible trigger factor can improve prognosis by promptly removing it.
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Affiliation(s)
- Francesco Moro
- Correspondence: (F.M.); (L.F.); Tel.: +39-(342)-802-0004 (F.M.)
| | - Luca Fania
- Correspondence: (F.M.); (L.F.); Tel.: +39-(342)-802-0004 (F.M.)
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8
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Zhang Y, Zhao Y, Jiang Y, Wang H. Effects of Epstein-Barr virus infection on liver function in children. J Infect Public Health 2019; 13:260-265. [PMID: 31831396 DOI: 10.1016/j.jiph.2019.11.009] [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: 10/07/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In order to analyze the effect of Epstein-Barr (EB) virus infection on the liver function of children, the age and season of children susceptible to EB virus were analyzed in this study. METHODS In this study, 118 children with EB infection from Cangzhou Central Hospital were selected as the subjects, and 10 children with normal liver function were selected as the control group. Compared with normal children, the changes of blood cells, immune cells and indicators related to liver function in patients with EB virus infection were compared, and the expression of EB virus -DNA in patients' peripheral blood was analyzed. Immunohistochemistry was used to analyze the location and changes of CD4+T lymphocytes, CD8+T lymphocytes, and granzyme B cells in the liver of the patients. And changes in liver tissue were studied by in situ hybridization. RESULTS It was found that children in early childhood (1-3 years old) were the most susceptible group, and summer and autumn were the most susceptible seasons. Compared with normal children, the number of red blood cells and white blood cells in patients infected with EB virus increased, while the number of platelets decreased, but the difference was not significant. The liver function indexes of Alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), and lactate dehydrogenase (LDH) increased after infection. The content of CD4+T lymphocytes decreased, while that of CD8+T lymphocytes increased. The level of immune factor IgG increased significantly (P<0.01), granzyme B cells were positive compared to that of normal humans, and positive lymphocytes containing EBER appeared. CONCLUSION Therefore, EB virus may affect liver function by acting CD8+T lymphocytes in children.
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Affiliation(s)
- Yongju Zhang
- Department of The Third Pediatrics, Cangzhou Central Hospital, No.16 XinHua Road, Cangzhou City, 061000, China
| | - Yuqi Zhao
- Department of The Third Pediatrics, Cangzhou Central Hospital, No.16 XinHua Road, Cangzhou City, 061000, China
| | - Yajing Jiang
- Department of The Third Pediatrics, Cangzhou Central Hospital, No.16 XinHua Road, Cangzhou City, 061000, China
| | - He Wang
- Department of The Third Pediatrics, Cangzhou Central Hospital, No.16 XinHua Road, Cangzhou City, 061000, China.
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Yang M, Wu H, Zhao M, Chang C, Lu Q. The pathogenesis of bullous skin diseases. J Transl Autoimmun 2019; 2:100014. [PMID: 32743502 PMCID: PMC7388362 DOI: 10.1016/j.jtauto.2019.100014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023] Open
Abstract
Bullous skin diseases are a group of dermatoses characterized by blisters and bullae in the skin and mucous membranes. The etiology and pathogenesis of bullous skin diseases are not completely clear. The most common are pemphigus and bullous pemphigoid (BP). Autoantibodies play critical roles in their pathogenesis. Abnormalities in the adhesion between keratinocytes in patients with pemphigus leads to acantholysis and formation of intra-epidermal blisters. Anti-desmoglein autoantibodies are present both in the circulation and skin lesions of patients with pemphigus. The deficient adhesion of keratinocytes to the basement membrane in BP patients gives rise to subepidermal blisters. Autoantibodies against the components of hemidesmosome can be detected in BP patients. Many novel therapeutics based on knowledge of the pathogenesis have emerged in recent years.
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Affiliation(s)
- Miao Yang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Haijing Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA, 95616, USA
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children’s Hospital, Hollywood, FL, 33021, USA
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
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Stevens NE, Cowin AJ, Kopecki Z. Skin Barrier and Autoimmunity-Mechanisms and Novel Therapeutic Approaches for Autoimmune Blistering Diseases of the Skin. Front Immunol 2019; 10:1089. [PMID: 31156638 PMCID: PMC6530337 DOI: 10.3389/fimmu.2019.01089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
One of the most important functions of the skin besides regulating internal body temperature includes formation of the barrier between the organism and the external environment, hence protecting against pathogen invasion, chemical and physical assaults and unregulated loss of water and solutes. Disruption of the protective barrier is observed clinically in blisters and erosions of the skin that form in autoimmune blistering diseases where the body produces autoantibodies against structural proteins of the epidermis or the epidermal-dermal junction. Although there is no cure for autoimmune skin blistering diseases, immune suppressive therapies currently available offer opportunities for disease management. In cases where no treatment is sought, these disorders can lead to life threatening complications and current research efforts have focused on developing therapies that target autoantibodies which contribute to disease symptoms. This review will outline the involvement of the skin barrier in main skin-specific autoimmune blistering diseases by describing the mechanisms underpinning skin autoimmunity and review current progress in development of novel therapeutic approaches targeting the underlying causes of autoimmune skin blistering diseases.
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Affiliation(s)
- Natalie E Stevens
- Regenerative Medicine Laboratory, Future Industries Institute, University of South Australia, Adelaide, SA, Australia
| | - Allison J Cowin
- Regenerative Medicine Laboratory, Future Industries Institute, University of South Australia, Adelaide, SA, Australia
| | - Zlatko Kopecki
- Regenerative Medicine Laboratory, Future Industries Institute, University of South Australia, Adelaide, SA, Australia
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Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol 2019; 20:97-114. [PMID: 30361953 DOI: 10.1007/s40257-018-0400-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases in the USA. If uncontrolled, diabetes can lead to devastating complications. Diabetes medications and medical devices largely contribute to the significant financial expense that the disease inflicts on affected individuals and society. Alongside significant economic burden, there are numerous cutaneous adverse effects associated with diabetes medications and medical devices. Despite the large and increasing number of individuals living with diabetes and the wide use of the related medications and medical devices, there is limited literature that comprehensively documents their cutaneous adverse effects. These cutaneous adverse effects are significant as they can worsen glycemic control, increase disease distress, and may increase risk of associated complications. Thus, it is important that providers can recognize these cutaneous adverse effects, identify the culprit agents, and can properly manage them. In this article, we provide a critical review of the cutaneous adverse effects of medications and devices used in the management of diabetes and provide insight into risk factors and prevention and an overview of therapeutic management. An emphasis is placed on clinical recognition and treatment for use of the medical providers who, regardless of practice setting, will treat patients with diabetes.
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