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Yamaga M, Miyauchi T, Peh JT, Itamoto S, Mai Y, Iwata H, Nomura T, Ujiie H. Case report: Difference in outcomes between two cases of Hailey-Hailey disease treated with apremilast. Front Genet 2022; 13:884359. [PMID: 36276960 PMCID: PMC9583697 DOI: 10.3389/fgene.2022.884359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Hailey-Hailey disease (HHD) is a rare autosomal dominant acantholytic dermatosis clinically characterized by recurrent erythematous plaques and erosions mainly on the intertriginous regions. Although HHD seriously affects quality of life, conventional treatments often fail to provide long-term relief for most patients. The effectiveness of apremilast, a phosphodiesterase-4 inhibitor, against severe HHD was first reported in 2018, and after further testing, this agent is currently expected to be established as an efficacious and safe therapeutic option. Here we report two cases of HHD treated with apremilast which showed opposite outcomes. Although the case with extremely severe symptoms showed remarkable and long-lasting improvement with apremilast used after acute treatment with oral corticosteroid, the other case, with milder symptoms treated only with apremilast, showed no improvement. Our transcriptome analysis using skin samples collected prior to apremilast administration revealed the involvement of the NF-κB signaling pathway, which is related to the responses to bacteria and other organisms. However, this pathway was more strongly activated in case 2 than in case 1, suggesting that the steroid treatment preceding apremilast may have been effective and supportive in the apremilast-responding case. One of the two cases highlights the potential of apremilast as a treatment option for HHD, but the other underlines the difficulties in managing HHD and the complexity of the disease background. The accumulation of cases and larger clinical studies are expected to precisely evaluate the safety and efficacy of apremilast, and the potential for therapies in combination with conventional treatments.
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Affiliation(s)
- Misako Yamaga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshinari Miyauchi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- *Correspondence: Toshinari Miyauchi,
| | - Jin Teng Peh
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sota Itamoto
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Dai Y, Yu L, Wang Y, Gao M, Wang P. Case Report: A Case of Hailey-Hailey Disease Mimicking Condyloma Acuminatum and a Novel Splice-Site Mutation of ATP2C1 Gene. Front Genet 2022; 12:777630. [PMID: 34970303 PMCID: PMC8712934 DOI: 10.3389/fgene.2021.777630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/26/2021] [Indexed: 12/11/2022] Open
Abstract
Hailey–Hailey disease (HHD) is a rare autosomal-dominant blistering disorder characterized by recurrent vesicular and erosive lesions at intertriginous sites. We described a 24-year-old male who presented with multiple bright red verrucous papules in his mons pubis, bilateral groins, scrotum, perineum, and crissum, clinically resembling condyloma acuminatum. The histopathology showed extensive acantholysis with the characteristic appearance of a dilapidated brick-wall. The mutation analysis revealed a novel splice-site mutation in the ATP2C1 gene. The patient was definitely diagnosed with HHD. The antibacterial treatments resulted in a dramatic improvement. Our findings help to broaden the understanding of clinical manifestations of HHD and improve the clinical diagnosis and treatment of this disease.
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Affiliation(s)
- Yuwei Dai
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Lingling Yu
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Yu Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Min Gao
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Peiguang Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
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3
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Antoñanzas J, Tomás-Velázquez A, Rodríguez-Garijo N, Estenaga Á, Salido-Vallejo R. Apremilast in combination with botulinum toxin-A injection for recalcitrant Hailey-Hailey disease. Int J Dermatol 2021; 61:600-602. [PMID: 34705274 DOI: 10.1111/ijd.15953] [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: 03/08/2021] [Revised: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Javier Antoñanzas
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Alejandra Tomás-Velázquez
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Nuria Rodríguez-Garijo
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Ángela Estenaga
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Rafael Salido-Vallejo
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, Pamplona, Spain.,Department of Dermatology, Reina Sofia University Hospital, Córdoba, Spain
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4
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Yoto A, Makino T, Mizawa M, Matsui Y, Takemoto K, Furukawa F, Kataoka K, Nakano H, Sawamura D, Shimizu T. Two cases of Hailey-Hailey disease effectively treated with apremilast and a review of reported cases. J Dermatol 2021; 48:1945-1948. [PMID: 34569085 DOI: 10.1111/1346-8138.16178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022]
Abstract
Hailey-Hailey disease (HHD) is an autosomal dominant genetic disease caused by a mutation of the ATP2C1 gene. Corticosteroids, antibiotics or cyclosporine have been administered to reduce inflammation and prevent flare-ups, but the efficacy is not always sufficient. We herein report two cases of HHD effectively treated with apremilast and review the previous literature. Patient 1 was a 28-year-old male and patient 2 was a 35-year-old female. Both patients were diagnosed with HHD based on histological and genetic analyses. Both patients were treated with oral antibiotics or topical corticosteroids, but their symptoms were refractory, therefore apremilast was administered to both patients. Two weeks later, the skin lesion of both patients was improved. No adverse reaction was observed except for mild headache in patient 2. There have been 13 reported cases of HHD treated with apremilast, including our cases. Eight cases showed a good response to apremilast, whereas five cases showed no response. There seems to be no association between the disease severity and efficacy of apremilast, although the reason remains unknown. Interestingly, an early improvement of the HHD lesion was observed in all good response cases. Although digestive symptoms, headache, and myalgia were observed as adverse events, the treatment was well-tolerated. The accumulation of a greater number of similar cases and further research will be required. We hypothesize that apremilast may be a useful therapeutic option for skin lesions of HHD.
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Affiliation(s)
- Ayumi Yoto
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Teruhiko Makino
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Megumi Mizawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yu Matsui
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Keita Takemoto
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Fumina Furukawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Kazuya Kataoka
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tadamichi Shimizu
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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5
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Riquelme-Mc Loughlin C, Iranzo P, Mascaró JM. Apremilast in benign chronic pemphigus (Hailey-Hailey disease). Clin Exp Dermatol 2020; 45:737-739. [PMID: 32198945 DOI: 10.1111/ced.14225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- C Riquelme-Mc Loughlin
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - P Iranzo
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J M Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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