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Vázquez-Osorio I, Salgado-Boquete L, Espasandín-Arias M, García-Martínez FJ, Sánchez-Aguilar D, Toribio J. Scrotal bullous pemphigoid in an elderly patient. Int J Dermatol 2014; 53:e389-90. [DOI: 10.1111/ijd.12405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Igor Vázquez-Osorio
- Departamento de Dermatología; Facultad de Medicina; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Laura Salgado-Boquete
- Departamento de Dermatología; Facultad de Medicina; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Martina Espasandín-Arias
- Departamento de Dermatología; Facultad de Medicina; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | | | - Dolores Sánchez-Aguilar
- Departamento de Dermatología; Facultad de Medicina; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Jaime Toribio
- Departamento de Dermatología; Facultad de Medicina; Complejo Hospitalario Universitario; Santiago de Compostela Spain
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Jabłońska S, Chorzelski TP, Rosinska D, Maciejowska E. Linear IgA bullous dermatosis of childhood (chronic bullous dermatosis of childhood). Clin Dermatol 1991; 9:393-401. [PMID: 1806227 DOI: 10.1016/0738-081x(91)90031-f] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Jabłońska
- Department of Dermatology, Warsaw Academy of Medicine, Poland
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Abstract
Pemphigoid is an autoimmune blistering disease that is rare in childhood. A review of the English, German, and French literature published prior to 1989 revealed 31 cases of juvenile bullous pemphigoid and 12 of other forms (10 cases of juvenile cicatricial and 2 of juvenile localized bullous pemphigoid). Childhood pemphigoid, although less frequent, seems no different than its adult counterpart. While oral lesions are more common in the juvenile bullous form, there is no association with malignancy, which is a controversial and presumably incorrectly assumed association in the adult disease. The prognosis for children is good in most cases, and the disease is self-limiting. The mainstay of therapy has been oral corticosteroids, but dapsone also often produces a good response. A relatively new approach is to give a combination of erythromycin and niacinamide with dapsone for a steroid-sparing effect. In some patients the response to erythromycin plus niacinamide alone has been satisfactory; however, controlled therapeutic trials are lacking. It has been stated that high doses of steroids and immunosuppressive drugs are indicated for the cicatricial, as opposed to juvenile, bullous pemphigoid. From this review of the few cases of childhood cicatricial disease, it seems that the therapeutic approach might be the same for both forms.
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Affiliation(s)
- A P Oranje
- Department of Dermatology and Venereology, Erasmus University, Rotterdam, The Netherlands
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Peters MS, Rogers RS. Clinical correlations of linear IgA deposition at the cutaneous basement membrane zone. J Am Acad Dermatol 1989; 20:761-70. [PMID: 2654216 DOI: 10.1016/s0190-9622(89)70087-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To determine the specificity of linear IgA deposition at the cutaneous basement membrane zone for primary bullous disease, we reviewed the results of all direct immunofluorescence studies of skin biopsy specimens taken from patients seen at Mayo Clinic during the period 1982 through 1986. Of 4642 specimens submitted for direct immunofluorescence during this 5-year period, 44 from 42 patients showed linear IgA deposition at the basement membrane zone, with or without other immunoglobulins. Of these 42 patients, 36 (86%) had primary subepidermal bullous disease. Of the 36, 20 had linear IgA without IgG at the basement membrane zone (10 with clinical adult linear IgA bullous dermatosis, 2 with chronic bullous disease of childhood, and 8 with cicatricial pemphigoid). Sixteen had linear IgA and IgG at the basement membrane zone (10 with clinical cicatricial pemphigoid, 5 with bullous pemphigoid, and 1 with epidermolysis bullosa acquisita). There was a high frequency of mucosal involvement (67% of the 36 patients) and a somewhat higher frequency of ocular involvement in patients with cicatricial pemphigoid who had linear IgA without IgG at the basement membrane zone (6 of 8) than in those who had both immunoglobulins at the basement membrane zone (4 of 10). These results show that the direct immunofluorescence finding of linear IgA deposition at the basement membrane zone correlates with primary subepidermal bullous disease in a high percentage of patients but reflects a heterogeneous group of blistering disorders.
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Affiliation(s)
- M S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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Moy W, Kumar V, Friedman RP, Schaeffer ML, Beutner E, Helm F. Cicatricial pemphigoid. A case of onset at age 5. J Periodontol 1986; 57:39-43. [PMID: 3511219 DOI: 10.1902/jop.1986.57.1.39] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cicatricial pemphigoid is a chronic subepidermal bullous dermatosis which primarily involves the mucous membranes. It is a disease found almost exclusively middle-aged and elderly persons. This report describes a case of cicatricial pemphigoid with onset at age 5 and involving primarily the mucous membranes of the mouth and eyes. The patient cleared well on 40 mg of Prednisone and has been maintained on a regimen of 7.5 mg of Prednisone every other day.
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Beutner EH, Chorzelski TP, Jablonska S. Immunofluorescence tests. Clinical significance of sera and skin in bullous diseases. Int J Dermatol 1985; 24:405-21. [PMID: 3902680 DOI: 10.1111/j.1365-4362.1985.tb05807.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lever RS, Morley WN, Dick HM, Fulton RA. Benign chronic bullous disease of childhood in an Indian child. Scott Med J 1985; 30:114-6. [PMID: 3892677 DOI: 10.1177/003693308503000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An Indian atopic child presented with benign chronic bullous disease of childhood (BCBDC). HLA grouping did not show the typical finding of HLA B8 which questions the value of HLA typing in this condition.
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Abstract
We followed three children who met the clinical, histologic, and immunologic criteria for chronic bullous disease of childhood (linear IgA dermatosis). All patients were able to discontinue therapy after two months to two years. Two have continued to experience transient mild episodes of blistering that have not required reinstitution of systemic therapy. In our opinion, children with this condition have a benign course with disease-free remissions and can be expected to discontinue all therapy eventually.
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Marsden RA. The treatment of benign chronic bullous dermatosis of childhood, and dermatitis herpetiformis and bullous pemphigoid beginning in childhood. Clin Exp Dermatol 1982; 7:653-63. [PMID: 6758997 DOI: 10.1111/j.1365-2230.1982.tb02491.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Leonard JN, Haffenden GP, Ring NP, McMinn RM, Sidgwick A, Mowbray JF, Unsworth DJ, Holborow EJ, Blenkinsopp WK, Swain AF, Fry L. Linear IgA disease in adults. Br J Dermatol 1982; 107:301-16. [PMID: 7052113 DOI: 10.1111/j.1365-2133.1982.tb00360.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A multi-centre study is described in which thirty-five adult patients with papillary IgA dermatitis herpetiformis (DH) were compared with forty-two patients with linear IgA deposits, of whom thirty-four had homogeneous-linear (HL) and eight had granular-linear (GL) IgA deposits. The three groups were similar with regard to age of onset, presence of circulating immune complexes and auto-antibodies, incidence of spontaneous remission, histology of lesional skin and response to dapsone. There was a female predominance in the HL group in contrast to the male predominance in the other two. It was not possible to diagnose the HL group clinically. Some patients had a rash typical of DH whilst others resembled pemphigoid. In the majority, however, no specific diagnosis could be made with confidence. The GL group clinically resembled the DH group. The incidence of positive potassium iodide patch tests was greater in the DH group than in the other two. An associated enteropathy was found in 24% of patients in the HL group, 30% of patients in the GL group and 85% of patients in the DH group. Fifty-six percent of HL patients had HLA-B8 compared with 50% in the GL group and 88% in the DH group. Patients with linear IgA deposits may not be a uniform group, but until they can be divided into specific subgroups (e.g. by ultrastructural localization of the deposit or by response to a gluten-free diet) we propose that the term adult linear IgA diseases should be used to distinguish these patients from those with papillary IgA deposits.
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Chappe SG, Esterly NB, Furey NL, Hurley JK, Hsueh W. Subepidermal bullous disease and glomerulonephritis in a child. J Am Acad Dermatol 1981; 5:280-9. [PMID: 7021614 DOI: 10.1016/s0190-9622(81)70093-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The infant described in this report had been generalized, subepidermal bullous eruption and concurrent glomerulonephritis. Immunofluorescence studies demonstrating deposition of immunoglobulin and complement in the skin and kidney suggest a common pathogenesis for the two disorders. The elevation of this infant's serum immunoglobulins and depression of serum complement support an immunologic process as the likely mechanism. It is important for clinicians caring for children with bullous skin diseases to search for evidence of renal disease and complement abnormalities.
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Safai B, Rappaport I, Matsuoka L, Sogn D, Haines K, Lewin M. Childhood dermatitis herpetiformis. Review of the new aspects and report of a case. J Am Acad Dermatol 1981; 4:435-41. [PMID: 7014663 DOI: 10.1016/s0190-9622(81)70043-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Dermatitis herpetiformis (DH) of linear IgA type occurred in a 6-month-old boy shortly after initiating sulfisoxazole therapy for a urinary tract infection. Generalized pruritic bullae on erythematous bases were present on his trunk and extremities. There were no clinical or laboratory findings suggestive of gastrointestinal involvement. Direct immunofluorescent studies of skin biopsies taken early in the course of the disease and while the child was on systemic corticosteroid therapy were negative. Eventually a linear deposition of IgA at the dermoepidermal junction of involved skin on direct immunofluorescence was demonstrated. No circulating antibodies to the basement membrane were found. Because of close proximity of the initiation of sulfisoxazole (Gantrisin) therapy and the eruption of the initial bullous lesions, this case also presents an interesting diagnostic and therapeutic problem. Negative assays of lymphocyte migration inhibition factor (LMIF) to sulfisoxazole indicated that the likelihood of a hypersensitivity reaction to sulfa drugs was slight. The patient's clinical response to dapsone therapy was dramatic. The conflicting views of subepidermal bullous dermatosis of childhood and the difficulties in confirming a diagnosis of DH are discussed. We contend that when DH is suspected in children, various laboratory tests should be repeated several times before the diagnosis can be confirmed. The case presented here is the youngest child reported with this type of DH.
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Jones RR, Goolamali SK. IgA bullous pemphigoid: a distinct blistering disorder. Case report and review of the literature. Br J Dermatol 1980; 102:719-25. [PMID: 7000138 DOI: 10.1111/j.1365-2133.1980.tb06575.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We report a patient with an eccrine carcinoma who developed localized blistering which clinically resembled pemphigoid, histologically showed subepidermal blistering with features of both dermatitis herpetiformis and bullous pemphigoid, responded to dapsone and exhibited linear IgA deposition on direct immunofluorescence. The nosological position of patients with linear IgA deposition and subepidermal blistering is not clear. A review of the literature reveals that in adults linear IgA deposition may occur in three separate situations: dermatitis herpetiformis, bullous pemphigoid and a third condition of which our case is an example which is best termed IgA bullous pemphigoid. This condition is distinguished from cases of dermatitis herpetiformis with linear IgA by the clinical features and the site of IgA deposition on immunoelectronmicroscopy. It is distinguished from cases of bullous pemphigoid with linear IgA by the absence of circulating IgG antibasement membrane zone antibody, the therapeutic response to dapsone and the frequent occurrence of circulating IgA antibasement membrane zone antibody. IgA bullous pemphigoid has not previously been reported with a carcinoma but the association lends further support to the concept that this eruption represents a variant of pemphigoid.
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Marsden RA, McKee PH, Bhogal B, Black MM, Kennedy LA. A study of benign chronic bullous dermatosis of childhood and comparison with dermatitis herpetiformis and bullous pemphigoid occurring in childhood. Clin Exp Dermatol 1980; 5:159-76. [PMID: 7002380 DOI: 10.1111/j.1365-2230.1980.tb01684.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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CHORZELSKI TADEUSZP, JABLONSKA STEFANIA. IgA linear dermatosis of childhood (chronic bullous disease of childhood). Br J Dermatol 1979. [DOI: 10.1111/j.1365-2133.1979.tb15096.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Of twenty-seven cases of subepidermal blistering disease of children twelve corresponded clinically, histologically and immunologically to dermatitis herpetiforms of adults, six to bullous pemphigoid, and eight to chronic bullous disease of childhood (CBDC), i.e. IgA linear dermatosis. This latter disease seems to be a distinct entity, different from both dermatitis herpetiformis and bullous pemphigoid, and is characterized immunopathologically by linear IgA deposits at the basement membrane zone. These cases usually do not show intestinal involvement and respond well to combined treatment with sulphones and corticosteroids, whereas sulphones or sulphapyridine alone are, even in very high doses, not sufficient for full control of the disease. CBDC or IgA linear dermatosis of childhood may be regarded as a counterpart of IgA linear dermatosis of adults.
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Dabrowski J, Chorzelski TP, Jablońska S, Kraińska T, Jarzabek-Chorzelska M. The ultrastructural localization of IgA deposits in chronic bullous disease of childhood (CBDC). J Invest Dermatol 1979; 72:291-5. [PMID: 376753 DOI: 10.1111/1523-1747.ep12531739] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A case of bullous disease in a child with linear IgA immune deposits at the basement membrane zone and with some clinical, histological, and electron microscopic characteristics both of dermatitis herpetiformis and bullous pemphigoid, is described. The bulla formed between the basal lamina and basal cell membranes as in bullous pemphigoid, but at the same time there were numerous inflammatory cells in the dermis just below the partly destroyed basal lamina and also abundant fibrin deposits in very recent bulla and in the skin, all of which is rather characteristic of dermatitis herpetiformis. Ultrastructurally, the IgA deposits were located chiefly below the lamina basalis (the dermal type) but also, though less abundantly, in the lamina lucida, very much as we have seen them to be in adult cases with linear IgA immune deposits at the basement membrane zone. The investigations have supplied further evidence showing the chronic bullous disease of childhood to be actually a counterpart of the form in adults with the same linear localization of IgA deposits.
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Thune PO, Husby G, Larsen TE, Solheim B, Ek J. Juvenile dermatitis herpetiformis and chronic acquired bullous disease in children. Clin Exp Dermatol 1978; 3:279-84. [PMID: 367643 DOI: 10.1111/j.1365-2230.1978.tb01499.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Piamphongsant T, Chaikittisilpa S, Kullavanijaya P. Bullous pemphigoid in childhood: report of three cases and a review of literature. Int J Dermatol 1977; 16:126-33. [PMID: 321370 DOI: 10.1111/j.1365-4362.1977.tb01841.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Three proven cases of bullous pemphigoid in childhood which responded to dapsone are reported. The clinical and immunological criteria for diagnosis were similar to those in the aged. This report emphasizes that the condition is a distinctive clinical entity and entirely different from dermatitis herpetiformis and benign chronic bullous dermatosis of childhood.
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Chorzelski TP, Jablonska S, Beutner EE, Maciejowska E, Jarzabek-Chorzelska M. Juvenile dermatitis herpetiformis versus "benign chronic bullous dermatosis of childhood." Are these immunologic diseases? J Invest Dermatol 1975; 65:447-50. [PMID: 1104719 DOI: 10.1111/1523-1747.ep12608189] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Seven cases of juvenile dermatitis herpetiformis have been investigated. Immunofluorescence and histologic studies were made in all and jejunal biopsies in three. Immunopathologic results were positive in all cases including one that had previously been reported to be negative. Two groups could be distinguished according to clinical and histologic criteria, response to sulfapyridine, and character of the immunoglobulin deposits. The first corresponded to dermatitis herpetiformis (DH) of adults, with characteristic lesions of the jejunal mucosa; the second corresponded either to bullous pemphigoid (BP), although in the majority of the cases without circulating antibasement-membrane antibodies, or to a mixed type with the combined features of DH and BP. Repeated biopsies with serial sections are essential for demonstrating immune deposits. The question arises whether any immunologically negative cases of "benign chronic bullous dermatosis of childhood" actually exist.
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Van Joost T. Circulating autoantibodies in skin diseases: a survey and comparison of immunofluorescence (IF) studies. Int J Dermatol 1975; 14:379-96. [PMID: 1099028 DOI: 10.1111/j.1365-4362.1975.tb00129.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Utilization of immunofluorescence in the diagnosis of bullous diseases, lupus erythematosus and certain other dermatoses. Int J Dermatol 1975; 14:83-100. [PMID: 1091572 DOI: 10.1111/j.1365-4362.1975.tb01423.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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