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Tang CH, Sue YM, Chang CL, Wang CC. Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population-based cohort study. J Dermatol 2023; 50:1568-1575. [PMID: 37665203 DOI: 10.1111/1346-8138.16948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
Bullous pemphigoid has a high incidence among dialysis patients. However, whether or not chronic dialysis is an independent risk factor of bullous pemphigoid remains unclear. We aimed to investigate the effect of chronic dialysis on the development of bullous pemphigoid and pemphigus. We performed a retrospective cohort study using records from Taiwan's National Health Insurance Research Database between 2008 and 2019. We identified a dialysis cohort that included patients on chronic hemodialysis and peritoneal dialysis, and the hazard ratios (HRs) for bullous pemphigoid and pemphigus were compared with those of a sex-, age-, and index-matched cohort, then the results were adjusted for various confounding factors. Among 93 538 patients on chronic dialysis and 93 538 patients in the control group, 287 and 139 developed incident bullous pemphigoid, and 45 and 35 developed incident pemphigus after a median follow-up of 3.7 and 5.6 years, respectively. The incidence rates of bullous pemphigoid in the dialysis patients and the control group were 74.2 and 25.2 per 100 000 person-years, respectively (difference between groups, P < 0.0001). The incidence rates of pemphigus in the dialysis patients and the control group were 11.6 and 6.3 per 100 000 person-years, respectively (difference between groups, P < 0.01). Cox proportional hazard adjustment showed the HR for bullous pemphigoid in dialysis patients was 2.12 (95% confidence interval [CI] 1.64-2.74, P < 0.0001) compared with the control group. Dialysis patients aged <75 years had an even higher risk of bullous pemphigoid development (5- to 8-fold) than the control group. The adjusted HR for pemphigus was not elevated in dialysis patients (adjusted HR 1.52, 95% CI 0.87-2.67, P = 0.14). Chronic dialysis is an independent risk factor for developing bullous pemphigoid, but not a risk factor for pemphigus. Physicians should be aware of the predisposition of chronic dialysis patients to bullous pemphigoid.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Yuh-Mou Sue
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Li Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chen Wang
- Department of Dermatology, Cardinal Tien Hospital, New Taipei City, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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2
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Corbella-Bagot L, Gil-Lianes J, Fernández-Vela J, Martí-Martí I, Alegre-Fernández M, Fuertes I, Garbayo-Salmons P, Bosch-Amate X, Guilabert A, Mascaró JM. Case Report: Localized bullous pemphigoid induced by local triggers: a case series and a proposal for diagnostic criteria based on a literature review. Front Immunol 2023; 14:1160779. [PMID: 37334352 PMCID: PMC10272756 DOI: 10.3389/fimmu.2023.1160779] [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: 02/07/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Localized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers. Methods We hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology. Results During follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors. Conclusion LBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases.
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Affiliation(s)
- Lluís Corbella-Bagot
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Gil-Lianes
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Ignasi Martí-Martí
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Alegre-Fernández
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Antonio Guilabert
- Department of Dermatology, Hospital General de Granollers, Granollers, Spain
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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3
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Noorily T, Ren V. Localized Bullous Pemphigoid. Mayo Clin Proc 2023; 98:903-904. [PMID: 37270271 DOI: 10.1016/j.mayocp.2023.02.001] [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: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Talia Noorily
- Department of Dermatology, Baylor College of Medicine, Houston, Texas.
| | - Vicky Ren
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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Stojičić M, Jurišić M, Marinković M, Karamarković M, Jovanović M, Jeremić J, Jović M, Vlahović A, Jovanović M, Radenović K, Jovićević N, Vasović D. Necrotizing Fasciitis-Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040745. [PMID: 37109703 PMCID: PMC10144771 DOI: 10.3390/medicina59040745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols.
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Affiliation(s)
- Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Vlahović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, 11000 Belgrade, Serbia
| | - Mladen Jovanović
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Jovićević
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dolika Vasović
- Clinic for Eye Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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5
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Maglie R, Mercurio L, Morelli M, Madonna S, Salemme A, Baffa ME, Quintarelli L, Di Zenzo GM, Antiga E, Albanesi C. Interleukin-36 cytokines are overexpressed in the skin and sera of patients with bullous pemphigoid. Exp Dermatol 2023. [PMID: 36940975 DOI: 10.1111/exd.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease, characterized by autoantibodies targeting BP180 and BP230. The role of interleukin (IL)-36, a potent chemoattractant for granulocytes, in BP remains elusive.The expression of IL-36 cytokines (IL-36α, β, γ) and their antagonists (IL-36Ra and IL-38) was analysed in the skin and serum samples of patients with BP (n = 31), psoriasis (n = 10) and healthy controls (HC) (n = 14) by quantitative polymerase chain reaction and enzyme linked immunosorbent assay, respectively. Skin and serum levels of all cytokines were correlated with the Bullous Pemphigoid Disease Area Index (BPDAI) score and with the serum concentration of pathogenic antibodies.IL-36α, IL-36β, IL-36γ and IL-36Ra were significantly (p < 0.05) overexpressed in BP skin compared to HC, without remarkable differences relative to psoriasis skin. The expression of IL-38 was significantly (p < 0.05) higher in BP compared to psoriasis skin.IL-36α and γ, but not β, serum concentrations were significantly (p < 0.05) higher in BP compared to HC. IL-36γ was significantly (p < 0.05) more expressed in the serum of psoriasis patients than BP. The serum concentration of IL-36Ra and IL-38 were similar between BP and HC, while IL-38 serum levels were significantly (p < 0.05) higher in BP compared to psoriasis patients. Serum IL-36α correlated significantly with BPDAI (r = 0.5 p = 0.001).IL-36 agonists are increased in BP patients, both locally and systemically. Serum IL-36α might represent a potential biomarker for BP. An inefficient balance between IL-36 agonists and antagonists is likely to occur during BP inflammation.
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Affiliation(s)
- Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Laura Mercurio
- Experimental Immunology Laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
| | - Martina Morelli
- Experimental Immunology Laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
| | - Stefania Madonna
- Experimental Immunology Laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
| | - Adele Salemme
- Molecular and Cell Biology laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
| | - Maria E Baffa
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni M Di Zenzo
- Molecular and Cell Biology laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Albanesi
- Experimental Immunology Laboratory, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy
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6
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The Intriguing Links between Psoriasis and Bullous Pemphigoid. J Clin Med 2022; 12:jcm12010328. [PMID: 36615129 PMCID: PMC9821109 DOI: 10.3390/jcm12010328] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
The coexistence of psoriasis with autoimmune bullous diseases (AIBDs), particularly bullous pemphigoid (BP), has been documented in case reports and series, as well as in epidemiological studies. The onset of psoriasis precedes that of BP in the majority of cases. Patients with concomitant BP and psoriasis are generally younger at the onset of BP and present with fewer erosions and blisters as compared with patients suffering from isolated BP. Intriguingly, it has been speculated that some BP cases with comorbid psoriasis can actually correspond to anti-laminin gamma-1 pemphigoid, a rare form that was recently recognized as a distinct entity and which can mimic BP and/or other subepidermal AIBDs. The pathomechanisms underlying the BP-psoriasis association have not yet been identified, although several hypotheses have been proposed. The most credited among such hypotheses involves the so-called "epitope spreading" phenomenon, with tissue injury secondary to a primary inflammatory process (i.e., psoriasis) leading to the exposure of sequestered antigens evoking a secondary autoimmune disease (i.e., bullous pemphigoid). This narrative review aims to give a brief overview of the association between psoriasis and BP, examining epidemiological, clinical, and immunopathological features, the pathomechanisms underlying this association, the treatments for psoriasis incriminated as potential triggers of BP, and the therapeutic management of patients with psoriasis and BP.
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7
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Maglie R, Baffa ME, Montefusco F, Pipitò C, Senatore S, Capassoni M, Maio V, Cerinic MM, Antiga E, Guiducci S. Case Report: Bullous Pemphigoid Associated With Morphea and Lichen Sclerosus: Coincidental Diseases or Pathogenetic Association? Front Immunol 2022; 13:887279. [PMID: 35592319 PMCID: PMC9110700 DOI: 10.3389/fimmu.2022.887279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Bullous pemphigoid (BP) represents the most common autoimmune bullous disease and is characterized by IgG autoantibodies targeting collagen XVII (BP180). BP has reportedly been occurred in association with other inflammatory skin diseases. Here, we describe the unusual occurrence of BP in a female patient with a concomitant history of generalized morphea (localized scleroderma, LoS) and cutaneous and genital lichen sclerosus (LiS). The occurrence of BP was associated with elevated serum levels of anti-BP180 IgG autoantibodies, which decreased upon clinical remission. Autoimmune bullous diseases and sclerosing dermatitis are immunologically distinct entities, whose association has been rarely described. In this study, we provide a literature review on cases of BP developed in patients with either LoS or LiS. Further, we discussed immunological mechanisms which may have favored the emergence of BP in our patient.
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Affiliation(s)
- Roberto Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Maria Efenesia Baffa
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Francesca Montefusco
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Carlo Pipitò
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Stefano Senatore
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Marco Capassoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit Azienda Ospedaliera Universitaria Careggi (AOUC), Florence, Italy
| | - Vincenza Maio
- Department of Health Sciences, Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit Azienda Ospedaliera Universitaria Careggi (AOUC), Florence, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit Azienda Ospedaliera Universitaria Careggi (AOUC), Florence, Italy
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8
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Maronese CA, Caproni M, Moltrasio C, Genovese G, Vezzoli P, Sena P, Previtali G, Cozzani E, Gasparini G, Parodi A, Atzori L, Antiga E, Maglie R, Moro F, Mariotti EB, Corrà A, Pallotta S, Didona B, Marzano AV, Di Zenzo G. Bullous Pemphigoid Associated With COVID-19 Vaccines: An Italian Multicentre Study. Front Med (Lausanne) 2022; 9:841506. [PMID: 35295599 PMCID: PMC8918943 DOI: 10.3389/fmed.2022.841506] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 01/06/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease caused by circulating autoantibodies toward the hemidesmosomal antigens BP180 and BP230. Cases of BP have been described following vaccinations against tetanus, poliomyelitis, diphtheria, influenza, pneumococcus, meningococcus, hepatitis B and rabies. The putative mechanism by which COVID-19-vaccines may induce BP has not been clarified. An Italian multicentre study was conducted to collect clinical, histopathological and immunopathological data of patients with BP associated with COVID-19-vaccines. Twenty-one cases were collected, including 9 females and 12 males (M/F = 1.3) with a median age at diagnosis of 82 years. Seventeen patients received the COMIRNATY Pfizer-BioNTech vaccine, two the Moderna mRNA-1273 vaccine, one the ChAdOx1/nCoV-19-AstraZeneca/ Vaxzevria vaccine and one received the first dose with the ChAdOx1/nCoV-19-AstraZeneca/Vaxzevria vaccine and the second dose with the COMIRNATY Pfizer-BioNTech vaccine. Median latency time between the first dose of anti-SARS-CoV-2 vaccine and the onset of cutaneous manifestations was 27 days. Median BPDAI at onset was 42. Eleven out of seventeen patients (65%) had positive titres for anti-BP180 antibodies with a median value of 106.3 U/mL on ELISA; in contrast, only five out of seventeen (29%) were positive for anti-BP230 antibodies, with a median of 35.3 U/mL. In conclusion, in terms of mean age, disease severity at diagnosis and clinical phenotype vaccine-associated BP patients seem to be similar to idiopathic BP with an overall benign course with appropriate treatment. On the other hand, the slight male predominance and the reduced humoral response to BP230 represent peculiar features of this subset of patients.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marzia Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Unità Sanitaria Locale Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Pamela Vezzoli
- Dermatology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Sena
- Dermatology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Department of Clinical Pathology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Cozzani
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Giulia Gasparini
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Aurora Parodi
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Laura Atzori
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Roberto Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Alberto Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Sabatino Pallotta
- Dermatology Clinic, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Biagio Didona
- Rare Disease Unit, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,*Correspondence: Giovanni Di Zenzo
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9
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Deotto ML, Spiller A, Sernicola A, Alaibac M. Bullous pemphigoid: An immune disorder related to aging (Review). Exp Ther Med 2021; 23:50. [PMID: 34934428 DOI: 10.3892/etm.2021.10972] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/29/2021] [Indexed: 01/09/2023] Open
Abstract
Bullous pemphigoid (BP) is the most frequent subepidermal autoimmune blistering disease and is caused by autoantibodies directed against two principal antigens of the hemidesmosome, BP antigen 180 and BP antigen 230. The pathogenesis of BP is dependent upon the interaction between genetic predisposition, physiological skin alterations due to aging and specific triggers. Several triggers have already been reported to induce this disease and include drugs, thermal or electrical burns, surgical procedures, trauma, UV radiation, radiotherapy, chemicals and infections. Data from the current literature support the hypothesis that alterations of the skin barrier associated with aging increase individual susceptibility to these aforementioned triggers. Consequently, this has been reported to lead to the attack of autoantibodies, demonstrating the predilection of BP for the elderly population. The identification of triggering factors and comorbidities may aid in understanding the pathogenesis of BP and improve clinical management by encouraging their prompt recognition and removal. Moreover, the present review has indicated that current management of BP should be aimed at counteracting the detrimental effects of aging on the skin by restoring skin barrier integrity and maintaining cutaneous homeostasis, for example with systematic applications of topical emollients and photoprotection. This strategy could prove even more beneficial in the elderly, in which frequent comorbidities associated with age often narrow available immunosuppressive treatment options. Furthermore, the safety of treatment regimens may significantly affect outcome and prognosis.
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Affiliation(s)
- Maria Ludovica Deotto
- Dermatology Unit, Department of Medicine, University of Padova, I-35121 Padua, Italy
| | - Alice Spiller
- Dermatology Unit, Department of Medicine, University of Padova, I-35121 Padua, Italy
| | - Alvise Sernicola
- Dermatology Unit, Department of Medicine, University of Padova, I-35121 Padua, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I-35121 Padua, Italy
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10
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Schmidt V, Blum R, Möhrenschlager M. Biphasic bullous pemphigoid starting after first dose and boosted by second dose of mRNA-1273 vaccine in an 84-year-old female with polymorbidity and polypharmacy. J Eur Acad Dermatol Venereol 2021; 36:e88-e90. [PMID: 34606112 DOI: 10.1111/jdv.17722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- V Schmidt
- Department of Dermatology, Hochgebirgsklinik Davos, Davos Wolfgang, Switzerland.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - R Blum
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland
| | - M Möhrenschlager
- Department of Dermatology, Hochgebirgsklinik Davos, Davos Wolfgang, Switzerland
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11
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Donaldson MR, Weber LA, Laggis CW. New onset bullous pemphigoid arising in Mohs surgical site. JAAD Case Rep 2021; 14:88-90. [PMID: 34295955 PMCID: PMC8282954 DOI: 10.1016/j.jdcr.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Matthew R. Donaldson
- Correspondence to: Matthew R. Donaldson, MD, 2655 Little Bookcliff Dr, Grand Junction, CO 81501.
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12
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Ständer S, Kasperkiewicz M, Thaçi D, Schmidt E, Zillikens D, Vorobyev A, Ludwig RJ. Prevalence and presumptive triggers of localized bullous pemphigoid. J Dermatol 2021; 48:1257-1261. [PMID: 33998059 DOI: 10.1111/1346-8138.15912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Bullous pemphigoid (BP) is an autoimmune skin disease, caused by autoantibodies to BP180 and/or BP230. While both these autoantigens are expressed in the entire skin, only some parts of the body become affected. Rare clinical observations indicate that BP may also manifest locally, usually following exposure to triggers. Here, we evaluated the occurrence and potential triggers of localized BP (LBP) in a cohort of 285 BP patients. Medical records of all BP patients hospitalized between 2009 and 2019 were reviewed. In 7/285 BP patients, a localized variant was identified. In 5/7 LBP patients, the disease remained local, while in 2/7 patients, an initial LBP subsequently spread. All cases were preceded by presumptive triggers, including previously described triggers and bacterial infections. Overall, LBP is rare. LBP, however, might be underdiagnosed and should thus be considered in the differential diagnosis, particularly when trigger factors preceded.
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Affiliation(s)
- Sascha Ständer
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Michael Kasperkiewicz
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Diamant Thaçi
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Comprehensive Center of Inflammation Medicine, University Hospital Schleswig-Holstein Campus, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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13
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Uthayakumar AK, Wilmot MC, Anketell P, Anjum N, Fearfield L. A blistering dermatosis within depigmented skin. Clin Exp Dermatol 2021; 46:1142-1145. [PMID: 33870539 DOI: 10.1111/ced.14636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A K Uthayakumar
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M C Wilmot
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - P Anketell
- Department of Histopathology, Charing Cross Hospital, London, UK
| | - N Anjum
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - L Fearfield
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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14
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Morimoto K, Yoshida T, Washida N, Uchiyama K, Nakayama T, Itoh H, Oya M. Bullous pemphigoid in patients receiving peritoneal dialysis: a case series and a literature survey. Ren Fail 2021; 43:651-657. [PMID: 33820495 PMCID: PMC8032334 DOI: 10.1080/0886022x.2021.1910045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease. Although several cases of BP in end-stage renal disease patients receiving peritoneal dialysis (PD) or hemodialysis have been reported, the incidence of BP in these patients remains unknown. We recently experienced three PD patients diagnosed with BP. The skin injury was likely to be a trigger of BP in all the three PD patients. Nifedipine and icodextrin exposures were possible factors directly or indirectly affecting the onset of BP, because they were common in the three cases. We also report that the incidence of BP in PD patients was 3/478.3 person-years in a single-center 10-year study. This case series with a literature survey describes that the skin and tissue injuries are potential triggers responsible for the onset of BP in dialysis patients and that the incidence of BP in these patients seems to be much higher than that in the general population.
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Affiliation(s)
- Kohkichi Morimoto
- Apheresis and Dialysis Center, School of Medicine, Keio University, Tokyo, Japan
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, School of Medicine, Keio University, Tokyo, Japan
| | - Naoki Washida
- Department of Nephrology, School of Medicine, International University of Health and Welfare, Otawara, Japan.,Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Mototsugu Oya
- Apheresis and Dialysis Center, School of Medicine, Keio University, Tokyo, Japan.,Department of Urology, School of Medicine, Keio University, Tokyo, Japan
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15
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Franken SM, Rustemeyer T. Bullous pemphigoid caused by contact allergy to bone cement: A case report. Contact Dermatitis 2020; 84:457-458. [PMID: 33277709 PMCID: PMC8246944 DOI: 10.1111/cod.13757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sylvie M Franken
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
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16
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Pemphigoïde localisée prétibiale secondaire à un hématome cutané. Ann Dermatol Venereol 2020; 147:905-906. [DOI: 10.1016/j.annder.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/26/2020] [Accepted: 06/03/2020] [Indexed: 01/03/2023]
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17
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Abbenante D, Raone B, Baraldi C, Loi C, Patrizi A, Bardazzi F. Trauma-induced bullous pemphigoid mimicking fracture blisters. Ital J Dermatol Venerol 2020; 156:411-412. [PMID: 33179880 DOI: 10.23736/s2784-8671.20.06740-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Diego Abbenante
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Beatrice Raone
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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18
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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: 70] [Impact Index Per Article: 17.5] [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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19
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Bullous pemphigoid development during the course of breast cancer: a radiation induced or a radiation recall dermatitis? JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Bullous pemphigoid (BP) is the most common autoimmune bullous disease, which is usually seen in older ages. Rarely, radiotherapy (RT) has been reported as a localised trigger factor for BP.Case:We present a case of a 64-year-old woman who underwent radical mastectomy and radiation therapy for breast cancer. Two months after the completion of RT with adjuvant Trastuzumab, a BP eruption developed in the irradiated area, spreading thereafter to other skin areas. The patient was treated with oral corticosteroids and the lesions evolved favourably.Conclusion:This case demonstrates a relatively benign skin reaction that could develop during the course of cancer treatment, which required co-management by oncologists, pathologists and dermatologists.
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20
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Drenovska K, Shahid M, Vassileva S. Nickel and Skin: From Allergy to Autoimmunity. Endocr Metab Immune Disord Drug Targets 2020; 20:1032-1040. [DOI: 10.2174/1871530320666191231115437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
Abstract
Introduction & Objectives:
Cutaneous and systemic reactions to various metal implants and
medical devices have been well documented. The aim of this review was to focus on the probable
common mechanisms of allergy and autoimmunity that may lead to similar clinical outcomes following
the growing evidence in the literature of metal and nickel-related systemic, autoimmune or autoinflammatory
disorders.
Methods:
Detailed search of the available electronic databases (PubMed-Medline) was conducted for
review of the literature on that topic till the present moment.
Results:
Multiple reports on the immunological effects of metals including immunomodulation, allergy,
or autoimmunity were identified. It was found that metals may act through immunosuppression,
immunotoxicity, or as immune adjuvants thus provoking allergy and autoimmunity in susceptible individuals.
Both external or internal exposure to metals was observed. Nickel has been identified as the
most common sensitizer, and also the most studied one. The coexistence of both allergic and autoimmune
symptoms, induced by nickel, has been published, suggesting the autoimmune potential of nickel
compounds.
Conclusions:
Clinical experience and scientific literature together demonstrate that metals may play an
important role in the development of autoimmune diseases. While metal implant allergies and complications
are on the rise, they remain a diagnostic and therapeutic challenge. Elucidation of their possible
mechanisms will contribute to the more successful and safer treatment of affected individuals.
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Affiliation(s)
- Kossara Drenovska
- Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria
| | - Martin Shahid
- Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria
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21
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Iriki H, Adachi T, Matsuda H, Chinen K, Arakawa H, Yamagami J, Nishie W, Yokouchi M. Case of dipeptidyl peptidase 4 inhibitor-associated bullous pemphigoid that developed after a scabies infestation. J Dermatol 2020; 47:e258-e260. [PMID: 32415680 DOI: 10.1111/1346-8138.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Hisato Iriki
- Department of Dermatology, Nerima General Hospital, Tokyo, Japan.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Adachi
- Department of Dermatology, Nerima General Hospital, Tokyo, Japan
| | - Hideshi Matsuda
- Departments of , Department of , Internal Medicine, Nerima General Hospital, Tokyo, Japan
| | - Katsuya Chinen
- Department of , Pathology, Nerima General Hospital, Tokyo, Japan
| | - Hiroki Arakawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Mariko Yokouchi
- Department of Dermatology, Nerima General Hospital, Tokyo, Japan.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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22
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Niebuhr M, Bieber K, Banczyk D, Maass S, Klein S, Becker M, Ludwig R, Zillikens D, Westermann J, Kalies K. Epidermal Damage Induces Th1 Polarization and Defines the Site of Inflammation in Murine Epidermolysis Bullosa Acquisita. J Invest Dermatol 2020; 140:1713-1722.e9. [PMID: 32057838 DOI: 10.1016/j.jid.2020.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 12/15/2022]
Abstract
Epidermolysis bullosa acquisita is an autoimmune skin disease characterized by subepidermal blisters. The pathogenesis is mediated by deposits of autoantibodies directed against type VII collagen in the skin, but the sequence of events regulating the localization of skin blisters is not fully understood. In this study, using the immunization-induced mouse model of epidermolysis bullosa acquisita, we demonstrate that epidermal disruption induces not only an infiltration of CD4+ T cells but also a T helper type 1 phenotype as it has been described for delayed-type hypersensitivity reactions. This T helper type 1 reaction was not found when different antigens were applied. Deep T-cell receptor β profiling revealed shifts in the V/J gene usage only in epidermolysis bullosa acquisita, suggesting an infiltration of autoantigen-specific T cells. To target these autoantigen-specific T cells, we established an approach with which skin inflammation could be prevented without impairing the functionality of autoantibodies. We conclude that T-cell involvement in skin blistering diseases such as epidermolysis bullosa acquisita relates not only to T-cell help for B cells that produce pathogenic autoantibodies but also to autoreactive T helper type 1 effector cells that migrate into injured skin sites, exacerbate inflammation through production of inflammatory cytokines such as IFNγ, and prevent wound healing.
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Affiliation(s)
- Markus Niebuhr
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Institute of Anatomy, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - David Banczyk
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | | | | | - Mareike Becker
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University Medical Center of Schleswig-Holstein, Lübeck, Germany
| | | | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany.
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23
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Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, likely triggered by scabies, in a hemodialysis patient with human leukocyte antigen-DQB1*03:01. CEN Case Rep 2020; 9:189-194. [PMID: 31993957 DOI: 10.1007/s13730-020-00452-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/18/2020] [Indexed: 12/20/2022] Open
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal bullous diseases. Autoantibodies against hemidesmosomal adhesion proteins might be involved in the developing process. BP usually affects the elderly with high mortality whereas the drug-induced BP is often improved and rarely relapses after the withdrawal of the suspected drug. An accumulated evidence suggests that dipeptidyl peptidase-4 inhibitor (DPP-4I), which has been widely used as the antidiabetic drug improves glycemic control with little risk for hypoglycemia, could be an inducer of DPP-4I-associated BP (DPP-4I-BP). While the precise mechanism remains unclear, a unique immunological profile with human leukocyte antigen (HLA)-DQB1*03:01 could be a biomarker of genetic susceptibility to DPP-4I-BP. Here, we encountered an interesting case of DPP-4I-BP with HLA-DQB1*03:01, which was likely triggered by scabies. A 56-year-old Japanese male with type 2 diabetes on hemodialysis was referred to our hospital due to worsened blisters. Prior to his admission, he had been on linagliptin, a DPP-4I, for 5 months. He then suffered from scabies 2 weeks before his admission while the treatment with ivermectin failed to improve his symptom. Based on his clinical symptom, positive for anti-BP180 autoantibody in serum, and the pathological alterations of skin biopsy specimens, he was diagnosed with DPP-4I-BP. Importantly, he also carried an HLA-DQB1*03:01 allele. Oral prednisolone was subsequently administered after the discontinuation of linagliptin, and his symptom gradually disappeared. Given the fact that the DPP-4I-BP could be a life-threating disease, we should be cautious of prescribing DPP-4I in hemodialysis patients, whose immune system could be impaired.
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24
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Maruyama A, Wada M, Kondo Y, Kira M, Nakano H, Katoh N. Case of bullous pemphigoid following Hailey-Hailey disease with novel mutation of the ATP2C1 gene. J Dermatol 2020; 47:e79-e80. [PMID: 31919896 DOI: 10.1111/1346-8138.15229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ayano Maruyama
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Wada
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukari Kondo
- Department of Dermatology, Ikeda City Hospital, Ikeda, Japan
| | - Masahiro Kira
- Department of Dermatology, Ikeda City Hospital, Ikeda, Japan
| | - Hajime Nakano
- Department of Dermatology, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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25
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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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26
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Leavitt E, Holland V. A case of atezolizumab‐induced photodistributed bullous pemphigoid. Dermatol Ther 2019; 32:e12924. [DOI: 10.1111/dth.12924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Erica Leavitt
- Division of DermatologyUniversity of California Los Angeles California
| | - Vanessa Holland
- Division of DermatologyUniversity of California Los Angeles California
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27
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Wang Y, Mao X, Wang D, Hammers CM, Payne AS, Wang Y, Jin H, Peng B, Li L. Anti-BP180 Autoantibodies Are Present in Stroke and Recognize Human Cutaneous BP180 and BP180-NC16A. Front Immunol 2019; 10:236. [PMID: 30863396 PMCID: PMC6399406 DOI: 10.3389/fimmu.2019.00236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/28/2019] [Indexed: 01/14/2023] Open
Abstract
Objective: Current evidence has revealed a significant association between bullous pemphigoid (BP) and neurological diseases (ND), including stroke, but the incidence of BP autoantibodies in patients with stroke has not previously been investigated. Our study aimed to assess BP antigen-specific antibodies in stroke patients. Design: One hundred patients with stroke and 100 matched healthy controls were randomly selected for measurement of anti-BP180/BP230 IgG autoantibodies by enzyme-linked immunosorbent assay (ELISA), salt-split indirect immunofluorescence (IIF), and immunoblotting against human cutaneous BP180 and BP180-NC16A. Results: Anti-BP180 autoantibodies were found in 14 (14.0%) patients with stroke and 5 (5.0%) of controls by ELISA (p < 0.05). Sera from 13 (13.0%) patients with stroke and 3 (3.0%) controls reacted with 180-kDa proteins from human epidermal extract (p < 0.05). 11 (11.0%) of stroke and 2 (2.0%) of control sera recognized the human recombinant full length BP180 and NC16A (p < 0.05). The anti-BP180-positive patients were significantly younger than the negative patients at the time of stroke (p < 0.001). Conclusion: Development of anti-BP180 autoantibodies occurs at a higher frequency after stroke, suggesting BP180 as a relatively common autoantigen after stroke and providing novel insights into BP pathogenesis in aging.
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Affiliation(s)
- Yanan Wang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
| | - Xuming Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Di Wang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
| | | | - Aimee S. Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Yiman Wang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy Medical Science, Beijing, China
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Dermatitis Herpetiformis and Celiac Disease Increase the Risk of Bullous Pemphigoid. J Invest Dermatol 2018; 139:600-604. [PMID: 30612975 DOI: 10.1016/j.jid.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022]
Abstract
Bullous pemphigoid (BP) and dermatitis herpetiformis (DH) are autoimmune bullous skin diseases. DH has been described to evolve into BP and the two diseases can have overlapping clinical appearances and diagnostic findings, but the association between DH and BP has not previously been studied in a large population. To evaluate DH and celiac disease as risk factors for BP, we conducted a retrospective case-control study of patients with BP and matched controls with basal cell carcinoma diagnosed in Finland between 1997 and 2013. A total of 3,397 patients with BP and 12,941 controls were included in the study. Forty-one (1.2%) BP patients and 7 (0.1%) controls had preceding DH. Diagnosed DH increased the risk of BP 22-fold (odds ratio = 22.30; 95% confidence interval = 9.99-49.70) and celiac disease 2-fold (odds ratio = 2.54; 95% confidence interval = 1.64-3.92) compared to controls. Eighteen (43.9%) of the patients who had DH and subsequent BP had bought dapsone during the 2 years prior to their BP diagnosis. Mean time between diagnosed DH and BP was 3 years. We conclude that diagnosis of DH is associated with a striking increase in the risk for BP.
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Julio TA, Vernal S, Massaro JD, Silva MC, Donadi EA, Moriguti JC, Roselino AM. Biological predictors shared by dementia and bullous pemphigoid patients point out a cross-antigenicity between BP180/BP230 brain and skin isoforms. Immunol Res 2018; 66:567-576. [PMID: 30220011 DOI: 10.1007/s12026-018-9028-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bullous pemphigoid (BP) following dementia diagnosis has been reported in the elderly. Skin and brain tissues express BP180 and BP230 isoforms. Dementia has been associated with rs6265 (Val66Met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene and low serum BDNF. Here we investigated a possible cross-antigenicity between BP180/BP230 brain and skin isoforms. We assessed antibodies against BP180/BP230 and BDNF levels by ELISA and BDNF Val66Met SNP by PCR in three groups: 50 BP patients, 50 patients with dementia, and 50 elderly controls. Heatmap hierarchical clustering and data mining decision tree were used to analyze the patients' demographic and laboratorial data as predictors of dementia-BP association. Sixteen percent of BP patients with the lowest serological BDNF presented dementia-BP clinical association. Anti-BP180/230 positivity was unexpected observed among dementia patients (10%, 10%) and controls (14%, 1%). Indirect immunofluorescence using healthy human skin showed a BP pattern in two of 10 samples containing antibodies against BP180/BP230 obtained from dementia group but not in the control samples. Neither allelic nor genotypic BDNF Val66Met SNP was associated with dementia or with BP (associated or not with clinical manifestation of dementia). Heatmap analysis was able to differentiate the three studied groups and confirmed the ELISA results. The comprehensive data mining analysis revealed that BP patients and dementia patients shared biological predictors that justified the dementia-BP association. Autoantibodies against the BP180/BP230 brain isoforms produced by dementia patients could cross-react with the BP180/BP230 skin isoforms, which could justify cases of dementia preceding the BP disease.
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Affiliation(s)
- Tamiris A Julio
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil
| | - Sebastian Vernal
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil
| | - Juliana D Massaro
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Matheus C Silva
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Eduardo A Donadi
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Julio C Moriguti
- Division of Gerontology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Ana M Roselino
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil.
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Azizpour A, Nasimi M, Shakoei S, Mohammadi F, Azizpour A. Bullous pemphigoid induced by Hijama therapy (cupping). Dermatol Pract Concept 2018; 8:163-165. [PMID: 30116655 PMCID: PMC6092080 DOI: 10.5826/dpc.0803a01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/11/2018] [Indexed: 11/02/2022] Open
Abstract
Bullous pemphigoid (BP) is described as a subepidermal blistering disorder, which is commonly reported among the elderly, particularly those older than 60 years of age. In this report, we present the case of a 41-year-old female patient with BP lesions that were initially detected at the site of Hijama therapy with a subsequent generalized spread. Punch biopsy from the lesions and perilesional direct immunofluorescence (DIF) demonstrated features of BP. The anti-BP180 level was 178 RU/mL, and the anti-BP230 level was negative. BP antigens at the site of Hijama caused an antibody response, which led to widespread blistering over the trunk due to epitope spreading. In a comprehensive review of the literature, a total of 22 BP patients with lesions due to physical trauma were studied, and clinical, immunological, and epidemiological information was gathered. This article is the first report on the occurrence of BP induced by Hijama therapy.
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Affiliation(s)
- Arghavan Azizpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Nasimi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Safoura Shakoei
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fariba Mohammadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Yavne Y, Amital D, Watad A, Tiosano S, Amital H. A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia. Semin Arthritis Rheum 2018; 48:121-133. [DOI: 10.1016/j.semarthrit.2017.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/11/2017] [Accepted: 12/09/2017] [Indexed: 01/09/2023]
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Cozzani E, Trave I, Burlando M, Parodi A. Erythematous Maculopapular Eruption Induced by Anastrozole: The First Case. Am J Ther 2018; 25:e743-e744. [PMID: 29668491 DOI: 10.1097/mjt.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Emanuele Cozzani
- Di.S.Sal. Section of Dermatology, University of Genoa, San Martino Policlinic Hospital, Genoa, Italy
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Mai Y, Nishie W, Sato K, Hotta M, Izumi K, Ito K, Hosokawa K, Shimizu H. Bullous Pemphigoid Triggered by Thermal Burn Under Medication With a Dipeptidyl Peptidase-IV Inhibitor: A Case Report and Review of the Literature. Front Immunol 2018; 9:542. [PMID: 29706950 PMCID: PMC5906537 DOI: 10.3389/fimmu.2018.00542] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/02/2018] [Indexed: 12/26/2022] Open
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering disease in which autoantibodies mainly target the hemidesmosomal component BP180 (also known as type XVII collagen) in basal keratinocytes. Various triggering factors are known to induce BP onset, including radiotherapy, burns, ultraviolet exposure, surgery, and the use of dipeptidyl peptidase-IV inhibitors (DPP4i), which are widely used antihyperglycemic drugs. Here, we present a case of BP triggered by a thermal burn under medication with DPP4i. A 60-year-old man with type II diabetes had been treated with the DPP4i linagliptin for 1 year. After the right forearm experienced a thermal burn, blisters developed around the burned area and gradually spread over the whole body with the production of autoantibodies targeting the non-NC16A domain of BP180. The diagnosis of BP was confirmed by immunohistopathological examination. Upon withdrawal of linagliptin and treatment with topical steroid and minocycline, complete remission was achieved after 4 months. Previously, 13 cases of BP that developed after thermal burns have been reported, and our case shared some of the clinical features of these thermal burn-induced BP cases. Interestingly, the present case also showed the typical clinical, histopathological, and immunological features of the non-inflammatory type of DPP4i-associated BP (DPP4i-BP). Although the pathogenesis of BP remains uncertain, the present case suggests that DPP4i may trigger the onset of BP similarly to a thermal burn. In addition, the clinical and histopathological features of DPP4i-BP may be distinct from other types of BP.
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Affiliation(s)
- Yosuke Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazumasa Sato
- Department of Dermatology, JR Sapporo Hospital, Sapporo, Japan
| | - Moeko Hotta
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kei Ito
- Department of Dermatology, JR Sapporo Hospital, Sapporo, Japan
| | | | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Thorslund K, Seifert O, Nilzén K, Grönhagen C. Incidence of bullous pemphigoid in Sweden 2005-2012: a nationwide population-based cohort study of 3761 patients. Arch Dermatol Res 2017; 309:721-727. [PMID: 28875235 PMCID: PMC5648739 DOI: 10.1007/s00403-017-1778-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 01/27/2023]
Abstract
Studies that report the incidence of bullous pemphigoid from validated nationwide population-based registries are rare. The aim of this study was to estimate the incidence of bullous pemphigoid in Sweden 2005–2012. A population-based open cohort study was designed including all patients diagnosed by a dermatologist with bullous pemphigoid (BP) in Sweden from 2005 to 2012 (n = 3761), identified from the National Patient Register (NPR). The diagnosis of bullous pemphigoid in the NPR was recently validated from medical records, histopathological and immunopathological data by our group in a previous study. The average annual incidence of bullous pemphigoid was 7.1/100,000 (95% CI 6.5–7.7). Female to male ratio was 1.2:1, mean age at diagnosis was 78.9 years. The age-specific incidence rate increased markedly after 80 years of age with an incidence peak between 90 and 99 years of age, 81.9/100,000 (95% CI 75.0–89.2). This large nationwide cohort study presents an adjusted incidence of BP of 7.1/100,000 (95% CI 6.5–7.7) in Sweden. The incidence of bullous pemphigoid is higher than expected and bullous pemphigoid is a common disease in the elderly population.
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Affiliation(s)
- Kristofer Thorslund
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Oliver Seifert
- Division of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Karin Nilzén
- Division of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden
| | - Carina Grönhagen
- Department of Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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Kosi L, Perić J, Pantović M, Bijelić G, Vukićević Sretenović J, Škiljević D. Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2016. [DOI: 10.1515/sjdv-2016-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions.
We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.
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Affiliation(s)
- Lucija Kosi
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
| | - Jelena Perić
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
| | - Milica Pantović
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
| | - Gorana Bijelić
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
| | - Jelica Vukićević Sretenović
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Department of Dermatovenereology, School of Medicine, University of Belgrade; Republic of Serbia
| | - Dušan Škiljević
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Belgrade, Republic of Serbia
- Clinic of Dermatovenereology, Clinical Center of Serbia ; Department of Dermatovenereology, School of Medicine, University of Belgrade; Republic of Serbia
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Kluger N, Mandelin J, Santti K, Jeskanen L, Nuutinen P. Bullous pemphigoid triggered by radiotherapy for breast cancer. Presse Med 2016; 46:128-130. [PMID: 27818063 DOI: 10.1016/j.lpm.2016.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Nicolas Kluger
- Helsinki University Hospital, University of Helsinki, Department of skin and allergic diseases, Helsinki, Finland.
| | - Johanna Mandelin
- Helsinki University Hospital, University of Helsinki, Department of skin and allergic diseases, Helsinki, Finland
| | - Kirsi Santti
- Helsinki University Hospital, University of Helsinki, Comprehensive Cancer Center, Helsinki, Finland
| | - Leila Jeskanen
- Helsinki University Hospital, University of Helsinki, Department of skin and allergic diseases, Helsinki, Finland
| | - Pauliina Nuutinen
- Helsinki University Hospital, University of Helsinki, Department of skin and allergic diseases, Helsinki, Finland
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Osipowicz K, Kalinska-Bienias A, Kowalewski C, Wozniak K. Development of bullous pemphigoid during the haemodialysis of a young man: case report and literature survey. Int Wound J 2016; 14:288-292. [PMID: 27748034 DOI: 10.1111/iwj.12670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022] Open
Abstract
Haemodialysis is the most frequent form of renal replacement therapy (RRT) in patients with end-stage renal disorder (ESRD). Patients with ESRD frequently develop skin problems, mainly xerosis, pruritus and hyperpigmentation, as well as bullous diseases, mainly porphyria or pseudoporphyria and, in some cases, bullous pemphigoid (BP). BP is the most common autoimmune sub-epidermal blistering disease, and it predominantly affects elderly people. Clinically, BP is characterised by generalised pruritic, bullous eruptions and urticaria-like lesions. Usually, BP is an idiopathic disorder; however, in some cases, underlying internal disorders are present, like diabetes or neurological disorders. Herein, we present a 33-year-old man with ESRD, maintained on haemodialysis, who developed BP. There are only six cases with BP provoked by the placement of a fistula for haemodialysis. BP in the current patient was confirmed by direct immunofluorescence (DIF) and indirect immunofluorescence using BIOCHIP. The patient responded promptly to tertracycline and 0·05% clobetasol propionate lesionally. However, the relationship between BP and the fistula for haemodialisys still remains unknown. It is highly likely that the skin injury associated with fistula placement was responsible for the alteration of the basement membrane zone (BMZ) and the stimulation of the immune system, leading to BP development. To explain the real role of fistula placement as a provocative factor in BP, other such cases are required for assessment.
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Affiliation(s)
- Katarzyna Osipowicz
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Wozniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
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