1
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Jordan TJM, Mamo LB, Olivry T, Liu Z, Bizikova P. Re-evaluating the prevalence of anti-desmocollin-1 IgA autoantibodies in canine pemphigus foliaceus. Vet Immunol Immunopathol 2024; 273:110773. [PMID: 38820947 PMCID: PMC11268094 DOI: 10.1016/j.vetimm.2024.110773] [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: 03/12/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
Pemphigus foliaceus (PF) is an autoimmune skin disease of dogs characterized by intraepidermal pustules containing neutrophils and dissociated keratinocytes that develop in association with circulating and tissue-bound IgG autoantibodies. A subset of IgG autoantibodies in canine PF target desmocollin-1 (DSC1), a component of intercellular adhesion complexes within the epidermis. Passive transfer of IgG autoantibodies from canine PF sera to mice was previously shown to induce skin disease in the absence of infiltrating neutrophils. In attempts to identify a mechanism responsible for neutrophil recruitment, past studies evaluated the prevalence of IgA autoantibodies in canine PF sera where they were found in <20% of affected dogs. We re-evaluated the prevalence of anti-DSC1 IgA in canine PF due to concerns regarding the sensitivity of previously used methods. We hypothesized that anti-DSC1 IgA are present in most dogs with PF but have been under-detected due to competition with concurrent anti-DSC1 IgG for binding to their mutual antigenic target. Despite removing approximately 80% of IgG from patient sera using affinity chromatography, we did not detect an increase in anti-DSC1 IgA by performing indirect immunofluorescence on canine DSC1-transfected HEK293T cells. Taken together, our results do not support a role for pathogenic IgA in canine PF.
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Affiliation(s)
- Tyler J M Jordan
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA; University of North Carolina School of Medicine, Department of Dermatology, 3122 Neuroscience Research Bldg., 115 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Lisa B Mamo
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Thierry Olivry
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Zhi Liu
- University of North Carolina School of Medicine, Department of Dermatology, 3122 Neuroscience Research Bldg., 115 Mason Farm Road, Chapel Hill, NC 27599, USA; University of North Carolina School of Medicine, Department of Microbiology and Immunology, 6th Floor Marsico Hall, 125 Mason Farm Road, Chapel Hill, NC 27599, USA; University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, 450 West Drive, Chapel Hill, NC 27514, USA
| | - Petra Bizikova
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA.
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2
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Yamanishi A, Ono N, Tsunoda A, Asahina Y, Fusumae T, Yamagami J, Sakai N, Ishii N, Amagai M, Takahashi H. A case of IgA pemphigus with acantholysis in oral mucosal lesions. SKIN HEALTH AND DISEASE 2024; 4:e327. [PMID: 38577061 PMCID: PMC10988733 DOI: 10.1002/ski2.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/23/2023] [Accepted: 12/24/2023] [Indexed: 04/06/2024]
Abstract
IgA pemphigus is an autoimmune bullous disease caused by anti-keratinocyte cell surface IgA autoantibodies. Mucous membrane involvement is rare in IgA pemphigus. We report a case of IgA pemphigus with oral mucosal lesions, in which acantholysis was pathologically confirmed. A 31-year-old woman presented with skin erythema with small pustules and oral mucosal erosions. Histopathological examination of the erosions on her oral mucosa and papules on her back revealed acantholysis and intraepidermal infiltration of neutrophils. Direct immunofluorescence tests showed intercellular deposition of IgA, but not IgG, mainly in the lower, but not entire, layer of the epidermis. C3 was linearly present in the basement membrane zone (BMZ), but not in the intercellular space. Enzyme-linked immunosorbent assay revealed that both anti-desmoglein (Dsg) 3 IgA and IgG were positive. Neither IgA nor IgG against desmocollin 1-3 were detected. This case was clinically and histologically compatible with IgA pemphigus, but immunologically anti-BMZ autoimmunity was additionally observed. IgA pemphigus is classified into two major types: subcorneal pustular dermatosis type and intraepidermal neutrophilic dermatosis type. This case was not typical in terms of rarely observed oral lesions and predominant deposition of IgA in the lower layer of the epidermis. Instead, this case could be considered a rare subtype of IgA pemphigus, IgA-pemphigus vulgaris. Oral lesions in IgA pemphigus may be clinical clue of having anti-Dsg3 IgA that cannot be routinely examined.
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Affiliation(s)
- Ayumi Yamanishi
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Noriko Ono
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Asako Tsunoda
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Yasuhiko Asahina
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Takayuki Fusumae
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Jun Yamagami
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Noriyasu Sakai
- Department of DermatologyTokyo Medical UniversityTokyoJapan
| | - Norito Ishii
- Department of DermatologyKurume University School of MedicineKurumeJapan
| | - Masayuki Amagai
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Hayato Takahashi
- Department of DermatologyKeio University School of MedicineTokyoJapan
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3
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Lluch-Galcerá JJ, Alcoverro C, Prat E, Martinez-Molina M, Bielsa I, Quer A, Bassas J. Refraktärer IgA-Pemphigus erfolgreich mit Adalimumab als Monotherapie behandelt. J Dtsch Dermatol Ges 2023; 21:1560-1562. [PMID: 38082513 DOI: 10.1111/ddg.15232_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/27/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Juan José Lluch-Galcerá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Carmen Alcoverro
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Eugeni Prat
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Manel Martinez-Molina
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Isabel Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Ariadna Quer
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Julio Bassas
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol | Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
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4
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Lluch-Galcerá JJ, Alcoverro C, Prat E, Martinez-Molina M, Bielsa I, Quer A, Bassas J. Refractory IgA pemphigus successfully managed with adalimumab as monotherapy. J Dtsch Dermatol Ges 2023; 21:1560-1562. [PMID: 37875783 DOI: 10.1111/ddg.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/27/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Juan José Lluch-Galcerá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Carmen Alcoverro
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Eugeni Prat
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Manel Martinez-Molina
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Isabel Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Ariadna Quer
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Julio Bassas
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Badalona, Barcelona, Spain
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5
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Costa LL, Bedrikow RB, Proença CGC, Lellis RF. Successful treatment with narrowband UVB in a recalcitrant case of IgA pemphigus. An Bras Dermatol 2023; 98:730-732. [PMID: 37142465 PMCID: PMC10404486 DOI: 10.1016/j.abd.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 05/06/2023] Open
Affiliation(s)
- Lilian Lemos Costa
- Department of Dermatology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Rute Facchini Lellis
- Department of Dermatology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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6
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Kodali N, Blanchard I, Kunamneni S, Lebwohl MG. Current management of generalized pustular psoriasis. Exp Dermatol 2023; 32:1204-1218. [PMID: 36779681 DOI: 10.1111/exd.14765] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare subset of psoriasis involving episodes of sterile pustules accompanied by inflammation and, often, systemic involvement. The inflammatory nature of GPP has potential for severe multisystem complications including high-output cardiac failure, infections, digestive system issues, and disfiguring or lethal acute flare episodes. The disease tends to have higher prevalence in females and Asians. The IL-1/IL-36 inflammatory pathway is a critical facet of GPP's pathology. Genetic mutations that are associated with GPP include modifications of Interleukin 36 Receptor Antagonist (IL36RN), Caspase Recruitment Domain Family Member 14 (CARD14), Adaptor Related Protein Complex 1 Subunit Sigma 3 (AP1S3), Myeloperoxidase (MPO) and Serpin Peptidase Inhibitor Clade A Member 3 (SERPINA3) genes. Treatment guidelines for GPP are not well-entrenched. Currently, only one GPP-specific treatment, the interleukin-36 receptor antagonist (IL-36Ra) spesolimab, has been approved for use in the United States. Additional anti-IL-36 pathway therapies are currently being developed. Other treatment options include other biologic therapies such as IL-17 inhibitors, IL-23 inhibitors and TNFα inhibitors. Non-biologic therapeutic options include retinoids, cyclosporine and methotrexate. Treatment options differ throughout the world; most countries utilize retinoids, cyclosporine and methotrexate as first-line non-biologic options. China and United Kingdom have no GPP-specific biologic therapies approved for use, while several biologic therapies are approved for use in Japan. This review aims to serve as an update on the current global management of GPP while also including relevant aspects of disease pathogenesis, diagnosis, clinical presentation, histopathology, aetiology and epidemiology.
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Affiliation(s)
- Nilesh Kodali
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Isabella Blanchard
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sruthi Kunamneni
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mark G Lebwohl
- Dermatology, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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7
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Hashimoto T, Qian H, Ishii N, Nakama T, Tateishi C, Tsuruta D, Li X. Classification and Antigen Molecules of Autoimmune Bullous Diseases. Biomolecules 2023; 13:703. [PMID: 37189450 PMCID: PMC10135556 DOI: 10.3390/biom13040703] [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: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Autoimmune bullous diseases (AIBDs), which are a group of tissue-specific autoimmune diseases of the skin, present with various blistering lesions on the skin and mucous membranes, and show autoantibodies of IgG, IgA and IgM against epidermal cell surfaces and basement membrane zone. To date, AIBDs have been classified into a number of distinct subtypes by clinical and histopathological findings, and immunological characteristics. In addition, various biochemical and molecular biological studies have identified various novel autoantigens in AIBDs, which has resulted in proposals of new subtypes of AIBDs. In this article, we summarized various distinct AIBDs, and proposed the latest and most comprehensive classification of AIBDs with their autoantigen molecules.
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Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hua Qian
- Department of Laboratory Medicine, Medical College, Dalian University, Dalian 116622, China
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Takekuni Nakama
- Department of Dermatology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Xiaoguang Li
- Department of Laboratory Medicine, Medical College, Dalian University, Dalian 116622, China
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8
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Delaleu J, Lepelletier C, Calugareanu A, De Masson A, Charvet E, Petit A, Giurgea I, Amselem S, Karabina S, Jachiet M, Mahevas T, Ram-Wolff C, Vignon-Pennamen MD, Bagot M, Battistella M, Bouaziz JD. Neutrophilic dermatoses. Rev Med Interne 2022; 43:727-738. [PMID: 35870984 DOI: 10.1016/j.revmed.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/27/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. ND are classified based upon the localization of neutrophils within the skin and clinical features. Recent findings suggest that ND are due to two main mechanisms: i) a polyclonal hereditary activation of the innate immune system (polygenic or monogenic); or ii) a clonal somatic activation of myeloid cells such as encountered in myelodysplastic syndrome or VEXAS syndrome. ND belong to internal medicine as a great number of patients with ND suffer from an underlying condition (such as hematological malignancy, inflammatory bowel disease, auto-immune and auto-inflammatory diseases). ND are diagnoses of exclusion and physicians should always consider differential diagnoses, particularly skin infections. Here, we review the pathophysiology and classification of the main ND (i.e., subcorneal pustular dermatosis (Sneddon-Wilkinson Disease) and Intercellular IgA dermatoses, aseptic pustulosis of the folds, Sweet syndrome, neutrophilic eccrine hidradenitis, pyoderma gangrenosum, erythema elevatum diutinum, neutrophilic urticarial dermatosis and neutrophilic panniculitis), their clinical and histopathological features, and we highlight the investigations that are useful to identify ND-associated diseases and to exclude the differential diagnoses.
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Affiliation(s)
- J Delaleu
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - C Lepelletier
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Calugareanu
- Service de dermatologie, Severe Cutaneous Adverse Reaction (SCAR) Regional Center, HCL, CHU de Lyon Centre, Lyon, France
| | - A De Masson
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - E Charvet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - I Giurgea
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Amselem
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Karabina
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - M Jachiet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - T Mahevas
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - C Ram-Wolff
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M-D Vignon-Pennamen
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M Battistella
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France.
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9
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Tognetti L, Cinotti E, Falcinelli F, Miracco C, Suppa M, Perrot JL, Rubegni P. Line-field confocal optical coherence tomography: a new tool for non-invasive differential diagnosis of pustular skin disorders. J Eur Acad Dermatol Venereol 2022; 36:1873-1883. [PMID: 35694879 PMCID: PMC9544527 DOI: 10.1111/jdv.18324] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
Background The spectrum of pustular skin disorders (PSD) is large and particularly challenging, including inflammatory, infectious and amicrobial diseases. Moreover, although pustules represent the unifying clinical feature, they can be absent or not fully developed in the early stage of the disease. The line‐field confocal optical coherence tomography (LC‐OCT) is a recently developed imaging technique able to perform a non‐invasive, in vivo, examination of the epidermis and upper dermis, reaching very high image resolution and virtual histology. Objectives We aimed to investigate the potentialities of LC‐OCT in the non‐invasive differential diagnosis of a series of 11 PSD with different aetiology, microscopic features, body location and incidence rates. Materials and Methods Complete LC‐OCT imaging (i.e. 2D/3D frames, videos) was performed on a total of 19 patients (10 females and 9 males) aged between 35 and 79 years. Images were blindly evaluated and compared with corresponding histopathologic findings. Results The LC‐OCT imaging was able to detect with high accuracy the pustule structure including shape, margins, morphology and cellular content, along with peculiar epidermal and adnexal alterations in each condition, including: Acute Generalized Exanthematous Pustulosis, Generalized pustular psoriasis, Generalized pustular figurate erythema, Subcorneal Pustular Dermatosis, Intraepidermal IgA pustulosis, Palmoplantar pustulosis, Palmoplantar pustular psoriasis. Herpetic whitlow, Acrodermatitis continua of Hallopeau, Vesicopustular Sweet syndrome and Vesicopustular Eosinophilic cellulitis, with pustular appearance, were also compared. Conclusions The new LC‐OCT can represent a rapid, non‐invasive and painless tool which can help differentiating among PSD of different aetiology and microscopic morphology in clinical mimickers in daily practice.
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Affiliation(s)
- L Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
| | - E Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy.,Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
| | - F Falcinelli
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
| | - C Miracco
- Department of Medicine, Surgery and Neurosciences Pathological Anatomy Section, University of Siena, Siena, Italy
| | - M Suppa
- Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J-L Perrot
- Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - P Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
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10
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Calmettes V, Badrignans M, Konstantinou MP, Tancrède-Bohin E, Vignon-Pennamen MD, Castel M, Pham-Ledard A, Le Roux-Villet C, Misery L, Schoenlaub P, Tronquoy AF, Cordel N, Ortonne N, Sohier P, Cellier L, Tournier E, De La Salle EM, Le Flahec G, Plantier F, Grootenboer-Mignot S, Jouen F, Hillion B, Aractingi S, Duvert-Lehembre S, Dupin N, Ingen-Housz-Oro S. IgA and IgG/IgA intercellular dermatosis: a clinicopathological case series of 15 patients. J Eur Acad Dermatol Venereol 2022; 36:e896-e898. [PMID: 35694900 DOI: 10.1111/jdv.18325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Affiliation(s)
- V Calmettes
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - M Badrignans
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - M P Konstantinou
- Department of Dermatology, University Hospital of Toulouse, Toulouse, France
| | - E Tancrède-Bohin
- Department of Dermatology, Saint Louis University Hospital, APHP, Paris, France
| | - M D Vignon-Pennamen
- Department of Pathology, Saint Louis University Hospital, APHP, Paris, France
| | - M Castel
- Department of Dermatology, University Hospital of Rouen, Rouen, France
| | - A Pham-Ledard
- Department of Dermatology, CHU Bordeaux and INSERM U1312, Bordeaux, France
| | - C Le Roux-Villet
- Department of Dermatology, University Hospital Avicenne, Bobigny, France
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - P Schoenlaub
- Department of Dermatology, Hopital d'Instruction des Armées, Brest, France
| | - A F Tronquoy
- Department of Dermatology, Hospital of Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - N Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, France
| | - N Ortonne
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - P Sohier
- Department of Pathology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - L Cellier
- Department of Pathology, University Hospital of Rouen, Rouen, France
| | - E Tournier
- Derpartment of Pathology, University Hospital of Toulouse, Toulouse, France
| | - E M De La Salle
- Department of Pathology, University Hospital of Lille, Lille, France
| | - G Le Flahec
- Department of Pathology, University Hospital of Brest, Brest, France
| | - F Plantier
- Cabinet de Pathologie Mathurin Moreau, Paris, France
| | | | - F Jouen
- Department of Immunology, University Hospital of Rouen, Rouen, France
| | - B Hillion
- Department of Dermatology, Hospital of Marne la Vallée, Jossigny, France
| | - S Aractingi
- Department of Dermatology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - S Duvert-Lehembre
- Department of Dermatology, Hospital of Dunkerque, Dunkerque, France.,Department of Dermatology, University Hospital of Lille, Lille, France
| | - N Dupin
- Department of Dermatology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - S Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France.,Univ Paris Est Créteil EpidermE, Créteil, France
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- French Bullous Diseases Study Group Paris, Paris, France
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11
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Alvarez-Payares JC, Molina A, Gallo S, Ramirez J, Hernandez J, Lopez F, Ramirez-Urrea SI, Álvarez C. Immune-Mediated Cutaneous Paraneoplastic Syndromes Associated With Hematologic Malignancies: Skin as a Mirror of Hematologic Neoplasms. Cureus 2021; 13:e19538. [PMID: 34934556 PMCID: PMC8668147 DOI: 10.7759/cureus.19538] [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] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Malignant neoplasms may present as paraneoplastic syndromes with mucocutaneous manifestations, which may or may not be chronologically associated. The pathophysiological mechanism is complex and not completely understood; therefore, definitive diagnosis may be achieved with a precise differential diagnosis based on the morphology of skin lesions, clinical picture, and histological pattern. The complexities, and low frequency, make the therapeutic approach quite challenging; consequently, the cornerstone of therapy is the eradication of the underlying neoplasms. Corticosteroids are the therapy of choice for most of these immune-mediated manifestations, but for the most part, the successful resolution requires the eradication of the underlying malignancy.
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Affiliation(s)
| | - Angel Molina
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Simon Gallo
- Dermatology, Universidad de Antioquia, Medellin, COL
| | - Julian Ramirez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Juan Hernandez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Fernando Lopez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
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12
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The epidemiology of autoimmune bullous diseases in Sudan between 2000 and 2016. PLoS One 2021; 16:e0254634. [PMID: 34255799 PMCID: PMC8277047 DOI: 10.1371/journal.pone.0254634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/01/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives Autoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan. Methods This was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016. Results Out of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita. Conclusions The clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials.
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13
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Emtenani S, Ghorbanalipoor S, Mayer-Hain S, Kridin K, Komorowski L, Probst C, Hashimoto T, Pas HH, Męcińska-Jundziłł K, Czajkowski R, Recke A, Sunderkötter C, Schneider SW, Hundt JE, Zillikens D, Schmidt E, Ludwig RJ, Hammers CM. Pathogenic Activation and Therapeutic Blockage of FcαR-Expressing Polymorphonuclear Leukocytes in IgA Pemphigus. J Invest Dermatol 2021; 141:2820-2828. [PMID: 34246620 DOI: 10.1016/j.jid.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
Pathomechanisms in IgA pemphigus are assumed to rely on Fc-dependent cellular activation by antigen-specific IgA autoantibodies; however, models for the disease and more detailed pathophysiologic data are lacking. In this study, we aimed to establish in vitro models of disease for IgA pemphigus, allowing us to study the effects of the interaction of anti-keratinocyte IgA with cell surface FcαRs. Employing multiple in vitro assays, such as a skin cryosection assay and a human skin organ culture model, in this study, we present mechanistic data for the pathogenesis of IgA pemphigus, mediated by anti-desmoglein 3 IgA autoantibodies. Our results reveal that this disease is dependent on FcαR-mediated activation of leukocytes in the epidermis. Importantly, this cell-dependent pathology can be dose-dependently abrogated by peptide-mediated inhibition of FcαR:IgA-Fc interaction, as confirmed in an additional model for IgA-dependent disease, that is, IgA vasculitis. These data suggest that IgA pemphigus can be modeled in vitro and that IgA pemphigus and IgA vasculitis are FcαR-dependent disease entities that can be specifically targeted in these experimental systems.
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Affiliation(s)
- Shirin Emtenani
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - Saeedeh Ghorbanalipoor
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - Sarah Mayer-Hain
- Department of Translational Dermatoinfectiology, University Hospital of Muenster, University of Muenster, Muenster, Germany; Institute of Immunology, University Hospital of Muenster, University of Muenster, Muenster, Germany
| | - Khalaf Kridin
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | | | | | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hendri H Pas
- Department of Dermatology, University of Groningen, Groningen, The Netherlands
| | - Kaja Męcińska-Jundziłł
- Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Andreas Recke
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - Cord Sunderkötter
- Department of Translational Dermatoinfectiology, University Hospital of Muenster, University of Muenster, Muenster, Germany; Department of Dermatology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jennifer E Hundt
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergology and Venerology, University of Luebeck, Luebeck, Germany
| | - Enno Schmidt
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany; Department of Dermatology, Allergology and Venerology, University of Luebeck, Luebeck, Germany
| | - Ralf J Ludwig
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany; Department of Dermatology, Allergology and Venerology, University of Luebeck, Luebeck, Germany
| | - Christoph M Hammers
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany; Department of Dermatology, Allergology and Venerology, University of Luebeck, Luebeck, Germany.
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14
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van Beek N, Zillikens D, Schmidt E. Bullous Autoimmune Dermatoses–Clinical Features, Diagnostic Evaluation, and Treatment Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:413-420. [PMID: 34369370 PMCID: PMC8380840 DOI: 10.3238/arztebl.m2021.0136] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/03/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bullous autoimmune dermatoses are a clinically and immunopatho - logically heterogeneous group of diseases, characterized clinically by blisters or erosions of the skin and/or mucous membranes. In Germany, their prevalence is approximately 40 000 cases nationwide, and their incidence approximately 20 new cases per million people per year. METHODS This review is based on publications that were retrieved by a selective search of the literature focusing on the current German and European guidelines. RESULTS Recent years have seen the publication of guidelines, controlled prospective clinical trials, and multicenter diagnostic studies improving both diagnosis and therapy. Specific monovalent and multivariate serological test systems and pattern analysis of tissue-bound autoantibodies allow identification of the target antigens in 80-90% of patients. This enables the precise classification of disease entities, with implications for treatment selection and disease outcome. In 2019, the anti-CD20 antibody rituximab was approved by the European Medicines Agency for the treatment of moderate and severe pemphigus vulgaris, with an ensuing marked improvement in the care of the affected patients. To treat mild and moderate bullous pemphigoid, topical clobetasol proprionate is recommended, in severe disease, combined with systemic treatment, i.e. usually (a) prednisolone p.o. at an initial dose of 0.5mg/kg/d , (b) an immunomodulant, e.g. dapsone or doxycycline, or (c) prednisolone plus an immunomodulant. CONCLUSION The early recognition and precise diagnostic evaluation of bullous autoimmune dermatoses now enables improved, often interdisciplinary treatment, in accordance with the available guidelines. Current research projects are focused on new treatment approaches, an improved understanding of the underlying pathophysiology, and further refinements of diagnostic techniques.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, Venereology, and Allergology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, Venereology, and Allergology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, Venereology, and Allergology, University of Lübeck, Lübeck, Germany
- Lu¨beck Institute of Experimental Dermatology (LIED), University of Lu¨beck, Lu¨beck, Germany
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15
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Kridin K, Schmidt E. Epidemiology of Pemphigus. JID INNOVATIONS 2021; 1:100004. [PMID: 34909708 PMCID: PMC8659392 DOI: 10.1016/j.xjidi.2021.100004] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Pemphigus is an epidemiologically heterogeneous group of autoimmune bullous diseases comprising pemphigus vulgaris (PV), pemphigus foliaceus, paraneoplastic pemphigus, IgA pemphigus, and pemphigus herpetiformis. Recently, our knowledge about the frequency of pemphigus, which is highly variable between different populations, has considerably expanded, and the first non-HLA genes associated with PV have been identified. In addition, a variety of comorbidities, including other autoimmune diseases, hematological malignancies, and psoriasis, have been described in this variant. Here, initial data about the impact of COVID-19 on this fragile patient population are discussed and perspectives for future epidemiological studies are outlined.
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Key Words
- ACE, angiotensin-converting enzyme
- AIBD, autoimmune bullous disease
- CAAR, chimeric autoantibody receptor
- CI, confidence interval
- DSG, desmoglein
- EADV, European Academy of Dermatology and Venereology
- EC, extracellular
- EMA, European Medicines Agency
- FS, fogo selvage
- HR, hazard ratio
- ICD, International Classification of Diseases
- PF, pemphigus foliaceus
- PNP, paraneoplastic pemphigus
- PV, pemphigus vulgaris
- SMR, standardized mortality ratio
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Affiliation(s)
- Khalaf Kridin
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enno Schmidt
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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16
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Solimani F, Meier K, Zimmer CL, Hashimoto T. Immune serological diagnosis of pemphigus. Ital J Dermatol Venerol 2020; 156:151-160. [PMID: 33228340 DOI: 10.23736/s2784-8671.20.06788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pemphigus is a rare autoimmune blistering disease which manifests with painful erosions and blisters of the skin and mucosa. This disorder is caused by autoantibodies attacking desmosomal proteins, necessary for cell-cell contact stability and epidermal integrity. Desmoglein (Dsg) 1 and Dsg3 are the two major target antigens in pemphigus. Yet, many other target proteins, which have been described over the years, seem to be involved in the loss of epidermal integrity. Clinical examination, combined to serological advances and detection of targeted antigens, permitted to differentiate among several pemphigus subtypes, in which pemphigus vulgaris and pemphigus foliaceus are the most common. Nowadays, serological analysis in pemphigus is a fundamental step of the diagnostic algorithm. This is based on analysis of clinical symptoms, histopathological examination of lesional skin, detection of tissue bound and circulating antibodies by direct and indirect immunofluorescence, and determination of target antigens either by enzyme-linked immunosorbent essay (ELISA) or by western blot analysis. A correct and exhaustive diagnostic algorithm is fundamental to characterize pemphigus subtypes, which lastly permits to adopt a correct treatment approach. Moreover, quality and quantity of circulating antibodies in patient's sera deliver important information regarding clinical course, disease severity and treatment response; thus, relevantly affecting physician's decision. To facilitate this process, "easy-to-perform" diagnostic kits with high sensitivity and specificity are being commercialized. In this review, we focus on available methods and established assays to correctly detect circulating autoantibodies in pemphigus. Moreover, we discuss subtype specific serological peculiarities in the five most relevant subtypes (pemphigus vulgaris, pemphigus foliaceus, pemphigus vegetans, paraneoplastic pemphigus and intercellular IgA dermatosis (also called as IgA pemphigus).
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany -
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christine L Zimmer
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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17
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Abstract
Direct immunofluorescence (DIF) remains a valuable tool that may be underused because of perceived challenges in the interpretation, limitations, and processing of DIF specimens. The aim of this review is to provide a practical guide for appropriately incorporating DIF in a variety of clinical diseases, such as autoimmune blistering disorders. In vasculitis, the role of DIF continues to evolve, particularly in the setting of IgA vasculitis. Although typically not indicated for the workup of connective tissue disease, DIF may be helpful in cases with negative serologies, nondiagnostic histologic findings, or scarring alopecia. Practical pearls for biopsy technique, specimen handling, and storage are also discussed.
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18
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Feldmeyer L, Ribero S, Gloor AD, Borradori L. Neutrophilic dermatoses with unusual and atypical presentations. Clin Dermatol 2020; 39:261-270. [PMID: 34272020 DOI: 10.1016/j.clindermatol.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neutrophilic dermatoses (NDs) are a group of reactive, noninfectious autoinflammatory diseases characterized by (1) infiltration of the epidermis, dermis, and or/hypodermis by neutrophils; (2) their association with distinct diseases (eg, hematologic malignancy and chronic inflammatory diseases); (3) potential extracutaneous involvement; and (4) response to anti-inflammatory drugs, such as corticosteroids, dapsone, colchicine, and novel biologic therapies, such as the anti-interleukin-1 blockade. Although distinct NDs have been described, transitional forms with overlapping features are often identified. These justify a simplified classification of NDs with three major forms: superficial (epidermal or pustular) NDs, dermal (en plaques) NDs, and deep NDs. We review selected or novel variants of NDs, including subcorneal pustular dermatosis, the group of immunoglobulin A neutrophilic dermatoses, amicrobial pustular dermatosis of the folds, and neutrophilic urticarial dermatosis, as well as atypical forms of Sweet syndrome and pyoderma gangrenosum closely mimicking severe infectious diseases. Knowledge of these variants is essential for proper diagnosis, adequate management, and avoidance of a dangerous escalation of therapy, such as unnecessary immunosuppression or extensive surgery.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Kaneko R, Tsunemi Y, Nakamura K, Kuramochi A, Tsuchida T, Koga H, Hashimoto T. A case of concurrent intercellular IgA dermatosis and linear IgA/IgG bullous dermatosis. Australas J Dermatol 2020; 61:e368-e369. [PMID: 32114716 DOI: 10.1111/ajd.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Reiko Kaneko
- Asahi Orthopaedic and Dermatology Clinic, Saitama, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | | | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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20
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Caraballo L, Mahapatra S, Dimov V, Eidelman FJ. The Striking Appearance of a Rare Skin Condition: "Half-Half" Blisters (Subcorneal Pustular Dermatosis). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:732-733. [PMID: 31611152 DOI: 10.1016/j.jaip.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Luis Caraballo
- Heart and Vascular Institute, Department of Vascular Medicine, Cleveland Clinic, Weston, Fla
| | | | | | - Frank J Eidelman
- Center for Medical Specialties, Department of Allergy and Immunology, Cleveland Clinic, Weston, Fla
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21
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Harrell J, Rubio XB, Nielson C, Hsu S, Motaparthi K. Advances in the diagnosis of autoimmune bullous dermatoses. Clin Dermatol 2019; 37:692-712. [PMID: 31864451 DOI: 10.1016/j.clindermatol.2019.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Autoimmune bullous dermatoses are defined by autoantibodies directed against adhesion proteins in the epidermis or basement membrane zone, resulting in blister formation on the skin and mucosa. Diagnosis depends on lesional biopsy for histopathology and perilesional biopsy for direct immunofluorescence. Additional diagnostic methods include indirect immunofluorescence, enzyme-linked immunosorbent assay, and immunoblot (Western blot), which may be selected in specific clinical scenarios due to improved sensitivity and/or specificity. This contribution reviews the available evidence supporting the use of each method to provide a practical reference for clinicians when diagnosing autoimmune bullous disorders. Techniques and cost are reviewed, and newer diagnostic techniques with potential for clinical application are.
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Affiliation(s)
- Jane Harrell
- University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Colton Nielson
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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22
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Drozhdina MB, Koshkin SV. Sneddon — Wilkinson disease: Review of the modern literature. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-1-15-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article provides a current overview of the correlation between a rare dermatosis — subcorneal pustulosis (Sneddon — Wilkinson disease) — and various diseases of internal organs; features of immunological changes; the role of desmocollin 1, chemoatractants, interleukin-1β, interleukin-6, interleukin-8, interleukin-10, leukotriene B4, tumour necrosis factor-alpha and K5a complement fraction in the pathogenesis of the disease. In this work, the authors describe the features of the clinical picture of the disease, as well as diagnostic criteria, including the use of serum protein electrophoresis. Histological features of the disease are discussed in detail. In addition, modern methods for treating this disease, including the use of dapsone, acitretin, infliximab, PUVA therapy are presented.
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Affiliation(s)
- M. B. Drozhdina
- Kirov State Medical University, Ministry of Health of the Russian Federation
| | - S. V. Koshkin
- Kirov State Medical University, Ministry of Health of the Russian Federation
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23
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Anouar I, Oukabli M, Hjira N, Boui M. [IGA Pemphigus]. Presse Med 2019; 48:461-464. [PMID: 30926207 DOI: 10.1016/j.lpm.2019.02.014] [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: 08/16/2018] [Revised: 11/29/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ilyass Anouar
- Hôpital militaire d'instruction Mohammed V, service de dermatologie, 10000 Hay Riad, Rabat, Maroc.
| | - Mohamed Oukabli
- Hôpital militaire d'instruction Mohammed V, service d'anatomopathologie, 10000 Hay Riad, Rabat, Maroc
| | - Naoufal Hjira
- Hôpital militaire d'instruction Mohammed V, service de dermatologie, 10000 Hay Riad, Rabat, Maroc
| | - Mohammed Boui
- Hôpital militaire d'instruction Mohammed V, service de dermatologie, 10000 Hay Riad, Rabat, Maroc
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24
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Oehler E, Fialek M. Des lésions cutanées sédimentaires. Rev Med Interne 2019; 40:199-200. [DOI: 10.1016/j.revmed.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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25
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Schauer F, Kern JS, Kiritsi D. Systemic retinoids for treatment of recalcitrant IgA pemphigus. Orphanet J Rare Dis 2018; 13:163. [PMID: 30227880 PMCID: PMC6145102 DOI: 10.1186/s13023-018-0899-y] [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: 02/28/2018] [Accepted: 08/24/2018] [Indexed: 11/08/2023] Open
Abstract
IgA pemphigus is an exceedingly rare autoimmune blistering disorder, caused by IgA autoantibodies against desmosomal proteins. No treatment option has been found to be universally effective. The disease is often recalcitrant to oral steroids and immunosuppressants. Here, we describe the use of systemic retinoids for the treatment of recalcitrant IgA pemphigus in 3 cases. Although the use of acitretin has been reported before, we present for the first time the positive effects of alitretinoin in treatment of 2 patients with IgA pemphigus. Besides hyperlipoproteinaemia requiring use of hypolipidemic agents in one case, alitretinoin was well-tolerated and has generally a more favorable side effect spectrum than immunosuppressants.
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Affiliation(s)
- Franziska Schauer
- Department of Dermatology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstr. 7, 79104, Freiburg, Germany
| | - Johannes Steffen Kern
- Department of Dermatology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstr. 7, 79104, Freiburg, Germany.,Royal Melbourne Hospital, Parkville and Box Hill Hospital - Monash University Eastern Health Clinical School, Box Hill, VIC, Australia
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstr. 7, 79104, Freiburg, Germany.
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26
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Antigen recognition in the pathogenesis of immunoglobulin A-related autoimmune bullous diseases. Postepy Dermatol Alergol 2018; 35:338-343. [PMID: 30206444 PMCID: PMC6130143 DOI: 10.5114/ada.2018.77663] [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: 03/14/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin A (IgA) is the most common subtype of antibodies in mucosal surfaces. In most of autoimmune bullous diseases, however, immunoglobulin G (IgG) is the main pathogenic antibody that plays a role through complementation. The IgA antibody for epidermal connection protein can be found in the sera of some patients with blistering skin disease. Of these patients, some have the IgA antibody in their sera, while others have IgG and IgA antibodies. IgA-related autoimmune bullous diseases are less common in clinical practice. In the past, these diseases were not fully understood and their classifications were confusing. Recently, some progress has been made in the study of these diseases.
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An Unusual Vesiculopustular Eruption: Answer. Am J Dermatopathol 2018; 40:703. [PMID: 30119105 DOI: 10.1097/dad.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hashimoto T, Teye K, Hashimoto K, Wozniak K, Ueo D, Fujiwara S, Inafuku K, Kotobuki Y, Jukic IL, Marinović B, Bruckner A, Tsuruta D, Kawakami T, Ishii N. Clinical and Immunological Study of 30 Cases With Both IgG and IgA Anti-Keratinocyte Cell Surface Autoantibodies Toward the Definition of Intercellular IgG/IgA Dermatosis. Front Immunol 2018; 9:994. [PMID: 29867971 PMCID: PMC5950707 DOI: 10.3389/fimmu.2018.00994] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/20/2018] [Indexed: 12/21/2022] Open
Abstract
Several sporadic cases, in which direct and indirect immunofluorescence studies simultaneously detected IgG and IgA autoantibodies to keratinocyte cell surfaces, have been reported mainly under the name of IgG/IgA pemphigus. However, there have been no systematic studies for this condition. In this study, we collected 30 cases of this condition from our cohort of more than 5,000 autoimmune bullous disease cases, which were consulted for our diagnostic methods from other institutes, and summarized their clinical and immunological findings. Clinically, there was no male-female prevalence, mean age of disease onset was 55.6 years, and mean duration before this condition was suspected was 18 months. The patients showed clinically bullous and pustular skin lesions preferentially on the trunk and extremities, and histopathologically intraepidermal pustules and blisters with infiltration of neutrophils and eosinophils. Immunologically, ELISAs frequently detected IgG and IgA autoantibodies to both desmogleins and desmocollins. From the characteristic clinical, histopathological, and immunological features, which are considerably different from those in classical IgG types of pemphigus, we propose this disease as a new disease entity with preferential name of intercellular IgG/IgA dermatosis (IGAD). This was the largest study of IGAD to date.
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Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
- Kurume University School of Medicine, Kurume, Japan
| | - Kwesi Teye
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Koji Hashimoto
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Katarzyna Wozniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sakuhei Fujiwara
- Department of Dermatology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kazuhiro Inafuku
- Department of Dermatology, Kimitsu Chuo Hospital, Kimitsu, Japan
| | - Yorihisa Kotobuki
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ines Lakos Jukic
- University Hospital Centre Zagreb, Department of Dermatology and Venereology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branka Marinović
- University Hospital Centre Zagreb, Department of Dermatology and Venereology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anna Bruckner
- Pediatric Dermatology, University of Colorado School of Medicine, Children’s Hospital Colorado, Denver, CO, United States
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marriana Medical University, Kawasaki, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
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Affiliation(s)
- D Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Affiliation(s)
- S Geller
- Department of Dermatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel
| | - E Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel
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Discrepancies among clinical, histological and immunological findings in IgA pemphigus: a case report and literature survey. Postepy Dermatol Alergol 2016; 33:480-484. [PMID: 28035228 PMCID: PMC5183777 DOI: 10.5114/pdia.2016.62486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
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