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Amin S, Fiore CT, Paek SY. Milia within resolving bullous pemphigoid lesions. Proc AMIA Symp 2019; 32:90-92. [PMID: 30956594 PMCID: PMC6442898 DOI: 10.1080/08998280.2018.1528962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022] Open
Abstract
Bullous pemphigoid (BP) is a blistering dermatosis characterized by an autoimmune response to two hemidesmosomal proteins, BP180 and BP230. We describe a case of an 80-year-old man diagnosed with BP by clinical features, histopathology, and immunosorbent assay who developed milia within resolving BP lesions. Milia formation during recovery is common in cases of mucous membrane pemphigoid and epidermolysis bullosa acquisita but has rarely been reported in cases of BP.
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Affiliation(s)
- Sima Amin
- Texas A&M College of Medicine, College StationTexas
| | - Connie T. Fiore
- Division of Dermatology, Baylor University Medical CenterDallasTexas
| | - So Yeon Paek
- Texas A&M College of Medicine, College StationTexas
- Division of Dermatology, Baylor University Medical CenterDallasTexas
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Uchida S, Oiso N, Koga H, Ishii N, Okahashi K, Matsuda H, Hashimoto T, Kawada A. Refractory bullous pemphigoid leaving numerous milia during recovery. J Dermatol 2016; 41:1003-5. [PMID: 25346302 DOI: 10.1111/1346-8138.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
Recovery with milia may occur in bullous pemphigoid (BP), mucous membrane pemphigoid (MMP) and epidermolysis bullosa acquisita (EBA). Scarring commonly occurs in MMP and EBA. Here, we report a 62-year-old man patient with BP, who was left with numerous milia during recovery. The patient had immunoglobulin (Ig)G autoantibodies to the recombinant protein of the BP180-NC16a domain and the soluble 120-kDa ectodomain of BP180 (linear IgA bullous dermatosis [LAD]-1). There are cases of BP with IgG autoantibodies to LAD-1 and/or the recombinant protein of BP180 C-terminal domain. Extensive milia formation during recovery may be associated with immunological predisposition and/or improper interaction between hemidesmosomes and the extracellular matrix components.
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Affiliation(s)
- Shusuke Uchida
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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3
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Walmsley N, Hampton P. Bullous pemphigoid triggered by swine flu vaccination: case report and review of vaccine triggered pemphigoid. J Dermatol Case Rep 2012; 5:74-6. [PMID: 22408707 DOI: 10.3315/jdcr.2011.1081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/26/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an acquired autoimmune blistering disease mainly affecting the elderly. Recent reports have shown an association with pre-existing neurodegenerative diseases. Triggers including diseases, medications and vaccination have been reported although in most patients no clear trigger is identified. MAIN OBSERVATIONS We report a case of atypical bullous pemphigoid which was strongly suspected to have been triggered by the swine flu vaccination. This is the first reported case of pemphigoid triggered by this vaccine. CONCLUSIONS The use of the swine flu vaccine is likely to increase in the future and it is important that clinicians are aware of the potential adverse effect of swine flu vaccination induced bullous pemphigoid.
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Affiliation(s)
- Natasha Walmsley
- Department of Dermatology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE2 2HA, UK
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4
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BERNARD P, BEDANE C, BONNETBLANC JM. Anti-BP180 autoantibodies as a marker of poor prognosis in bullous pemphigoid: a cohort analysis of 94 elderly patients. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.6581643.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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TANAKA M, HASHIMOTO T, DYKES P, NISHIKAWA T. Clinical manifestations in 100 Japanese bullous pemphigoid cases in relation to autoantigen profiles. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1996.tb00006.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Drummond A, Gupta G, Swan IR, Thomson J. An inflammatory desquamative dermatosis of the ear with anti-180 kDa antibodies: localized cicatricial pemphigoid? Br J Dermatol 2000; 142:815-6. [PMID: 10792241 DOI: 10.1046/j.1365-2133.2000.03435.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Kyriakis KP, Paparizos VA, Panteleos DN, Tosca AD. Re-evaluation of the natural course of bullous pemphigoid. A prospective study. Int J Dermatol 1999; 38:909-13. [PMID: 10632769 DOI: 10.1046/j.1365-4362.1999.00754.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few studies of prospectively collected data regarding the natural course of bullous pemphigoid have been performed. METHODS The following factors were combined both quantitatively and qualitatively to obtain results: gender, clinical activity based on the estimation of the body area involvement, disease duration, relapses, coexistence with other disease states, and serology Twenty-seven consecutive patients were followed up for 1 year. RESULTS Most disease activity (85.2%) is exhibited in the first year after onset. There is a lack of parameters with clear predictive significance. The extent and severity of skin involvement are equally distributed between the sexes and not affected by the disease duration. The generalized form of the disease is predominant (86.5%). The average clinical activity in relapses within the year of follow-up is 48% of the initially observed attack. The probability for recurrence is higher in seropositive patients (overall 37%). Coexistence with other disease states seems to be a random chance event. CONCLUSIONS The lack of parameters with predictive importance underlines the necessity of a thorough follow-up to prevent treatment-related complications in elderly patients.
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Affiliation(s)
- K P Kyriakis
- Department of Dermatology, West Attica General Hospital, Athens, Greece
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Abstract
Pemphigus and bullous pemphigoid are distinct autoimmune blistering diseases that are characterised by the presence of autoantibodies directed against specific adhesion molecules of the skin and mucous membranes. The comparison and contrast of molecular mechanism of blister formation of these two diseases provide a rational diagnostic and therapeutic approach to affected patients.
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Affiliation(s)
- H C Nousari
- Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2196, USA.
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Jung M, Kippes W, Messer G, Zillikens D, Rzany B. Increased risk of bullous pemphigoid in male and very old patients: A population-based study on incidence. J Am Acad Dermatol 1999; 41:266-8. [PMID: 10426901 DOI: 10.1016/s0190-9622(99)70061-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
No data are available on gender- and age-specific incidences for bullous pemphigoid (BP). The aim of this study was to calculate incidences for different gender- and age-strata and to assess risk differences between these strata in BP. A retrospective population-based cohort was recruited from all patients diagnosed with BP in 2 well-defined regions of Germany. The average population number was 1.7 million, and the observation period was 9 years (1989-1997). Incidences were calculated as newly diagnosed cases for a population of 1 million per year. Confidence intervals (CI) were estimated based on a Poisson distribution. For evaluation of risk between different age and gender strata a Poisson regression analysis was used. The highest incidence was calculated for individuals older than 90 years, with 398 (CI: 360, 439) new cases of BP per 1 million residents for men, and 87 (CI: 70, 108) new cases per 1 million residents for women. Risk (95% CI) was 1.9 (1.3, 2.9) fold higher in men than in women. In addition, the risk for BP was increased for patients above the age of 60 years. The highest risk was found for patients older than 90 years. For this age group, the risk was 297 (CI: 107, 826) fold higher than in patients 60 years of age and younger. Men are affected by BP almost twice as often as women. The risk for BP increases rapidly beyond the age of 60 years. Because the structure of the European population is shifting towards the aged, more people are expected to suffer from BP in the coming decades.
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Affiliation(s)
- M Jung
- Department of Dermatology, Mannheim Medical School, Ruprechts-Karls-University of Heidelberg, Mannheim, Germany
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Katsumi S, Muramatsu T, Kobayashi N, Nakatani C, Shirai T. Bullous pemphigoid preceded by recurrent oral lesions: identification of autoantibodies against BP180 by immunoblot using epidermal extracts and BP180 fusion proteins. Br J Dermatol 1999; 141:157-9. [PMID: 10417536 DOI: 10.1046/j.1365-2133.1999.02941.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kirtschig G, Venning VA, Wojnarowska F. Bullous pemphigoid: correlation of mucosal involvement and mucosal expression of autoantigens studied by indirect immunofluorescence and immunoblotting. Clin Exp Dermatol 1999; 24:208-12. [PMID: 10354183 DOI: 10.1046/j.1365-2230.1999.00457.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty patients with bullous pemphigoid were studied prospectively: sequential sera, in different phases of the disease, were collected over a period of approximately 2 years. The sera were tested using standard immunofluorescence techniques with salt-split and intact human tissue from different sites of the body (thigh, breast, oral mucosa, vagina); an early serum of each patient was tested by Western blotting. The concentration of circulating antibodies detected by the intact skin and intact mucous membranes was similar; split tissue was more sensitive than intact tissue. For eight of 19 patients, split vagina and occasionally split oral mucosa (in the same patients) were much less sensitive than all other tissues. Furthermore, there was a correlation between autoantibody reactivity with split mucous membrane tissues and clinical mucosal involvement. These results strongly suggest heterogeneity of antigens or epitopes expressed between tissues. In both split skin and mucosa all sera consistently detected an antigen on the epidermal side of the split regardless of the stage of the disease. Immunoblotting studies showed no correlation between specific antigens and mucosal expression or skin involvement.
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Affiliation(s)
- G Kirtschig
- Departments of Dermatology, Oxford Radcliffe Hospitals, Oxford OX3 7L J, UK
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Haase C, Büdinger L, Borradori L, Yee C, Merk HF, Yancey K, Hertl M. Detection of IgG autoantibodies in the sera of patients with bullous and gestational pemphigoid: ELISA studies utilizing a baculovirus-encoded form of bullous pemphigoid antigen 2. J Invest Dermatol 1998; 110:282-6. [PMID: 9506450 DOI: 10.1038/sj.jid.5602955] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Autoantibodies against the extracellular domain of bullous pemphigoid antigen 2 (BPAG2) are thought to play a key role in the pathogenesis of bullous pemphigoid and their detection may thus be of diagnostic and prognostic value. The aim of this study was to develop a standardized enzyme-linked immunosorbent assay utilizing the baculovirus-derived protein BV13 (extracellular domain of BPAG2 devoid of 68 amino acids at the C terminus linked to glutathione-S-transferase and 6x His tag) to detect BPAG2-specific autoantibodies. For the enzyme-linked immunosorbent assay, nickel agarose affinity-purified BV13 protein was incubated with sera from patients with bullous pemphigoid (n = 39), gestational pemphigoid (n = 10), and pemphigus vulgaris/pemphigus foliaceus (PV/PF; n = 15), or normal human sera (NHS; n = 18). Nickel affinity-purified proteins from wild-type baculovirus-infected insect cells served as a control. A positive enzyme-linked immunosorbent assay value was defined as reactivity (OD(BV13) - OD(WT)) > mean reactivity + 1 SD of the negative control sera (PV/PF; NHS). Thirty-five of 39 bullous pemphigoid sera and 10 of 10 gestational pemphigoid sera were reactive to BPAG2 compared with none of 15 PV/PF sera and one of 18 NHS (sensitivity, 91.8%; specificity, 97%). Of 16 BPAG2-reactive sera in the enzyme-linked immunosorbent assay, only six were BPAG2-reactive in the western blot, whereas 14 sera immunoprecipitated BPAG2 from extracts of epidermal keratinocytes. The enzyme-linked immunosorbent assay utilizing an eukaryotic BPAG2 protein thus seems to be highly sensitive and specific in the detection of BPAG2-specific antibodies and, hence, may be useful in the diagnosis of bullous autoimmune diseases, such as bullous pemphigoid and gestational pemphigoid.
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Affiliation(s)
- C Haase
- Hautklinik der RWTH Aachen, Germany
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BERNARD P, BEDANE C, BONNETBLANC JM. Anti-BP180 autoantibodies as a marker of poor prognosis in bullous pemphigoid: a cohort analysis of 94 elderly patients. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb03654.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Muramatsu T, Iida T, Tada H, Hatoko M, Kobayashi N, Ko T, Shirai T. Bullous pemphigoid associated with internal malignancies: identification of 180-kDa antigen by western immunoblotting. Br J Dermatol 1996; 135:782-4. [PMID: 8977682 DOI: 10.1111/j.1365-2133.1996.tb03891.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report three cases of bullous pemphigoid associated with internal malignancies. Two cases were associated with gastric cancer and one with rectal cancer. Immunoblot analysis, using epidermal extract of normal human skin, revealed that these patients' sera reacted only with bullous pemphigoid antigen with a molecular weight of 180 kDa (BP180). The relationship of BP180 to malignant tumours is discussed.
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Affiliation(s)
- T Muramatsu
- Department of Dermatology, Nara Medical University, Japan
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Harrison PV, Blewitt RW, Allen J, Wojnarowska F, Adamson AR, Jones CJP, Aplin JD, Church HJ. Bullous pemphigoid and ulcerative colitis: a report of two cases and description of immunoblot findings. Br J Dermatol 1996. [DOI: 10.1111/j.1365-2133.1996.tb16257.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Harrison PV, Blewitt RW, Allen J, Wojnarowska F, Adamson AR, Jones CJP, Aplin JD, Church HJ. Bullous pemphigoid and ulcerative colitis: a report of two cases and description of immunoblot findings. Br J Dermatol 1996. [DOI: 10.1046/j.1365-2133.1996.t01-4-53778.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kirtschig G, Walkden VM, Venning VA, Wojnarowska F. Bullous pemphigoid and multiple sclerosis: a report of three cases and review of the literature. Clin Exp Dermatol 1995; 20:449-53. [PMID: 8857334 DOI: 10.1111/j.1365-2230.1995.tb01375.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Three patients with longstanding multiple sclerosis (MS) who developed bullous pemphigoid (BP) are reported. All patients had immunological features of typical BP as determined by immunofluorescence and Western immunoblotting studies. The clinical features, however, differed from those observed in typical BP. In two the BP started near an indwelling catheter and two had striking involvement of the soles. None of our patients, or a further nine cases reported in the literature, had mucous membrane involvement. In MS patients BP appears to develop at a younger age. Multiple drugs were taken by the MS patients; these, however, appear not to play a role in triggering their BP. The course of BP in patients with MS is moderate, although the majority require systemic treatment.
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Affiliation(s)
- G Kirtschig
- Department of Dermatology, University Hospital Marburg, Germany
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Yell JA, Allen J, Wojnarowska F, Kirtschig G, Burge SM. Bullous systemic lupus erythematosus: revised criteria for diagnosis. Br J Dermatol 1995; 132:921-8. [PMID: 7662571 DOI: 10.1111/j.1365-2133.1995.tb16950.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Blistering in systemic lupus erythematosus has been divided into three groups. A specific subgroup of 'bullous systemic lupus erythematosus' has been defined by Gammon et al. on the basis of a number of criteria. From our experience of seven patients with bullous systemic lupus erythematosus, and after reviewing the literature, we suggest that the current classification is too narrow. Our patients displayed clinical and immunohistological (based on direct and indirect immunofluorescence and Western immunoblotting) heterogeneity. Sera from two patients bound to epidermal epitopes in sodium chloride-split skin, but immunoblotting was negative. In neither of these patients could the target antigen be type VII collagen, the only antigen identified as pathogenic in this disease. Patients with epidermal binding should not be excluded from a diagnosis of bullous systemic lupus erythematosus. SLE is a disease in which there is a genetic predisposition to form antibodies to type VII collagen, along with other autoantibodies, many of which may be implicated in blistering. We suggest that the criteria for the diagnosis of BSLE should be revised. We define this disease as an acquired subepidermal blistering disease in a patient with SLE, in which immune reactants are present at the basement membrane zone on either direct or indirect immunofluorescence.
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Affiliation(s)
- J A Yell
- Department of Dermatology, Churchill Hospital, Oxford, U.K
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Kirtschig G, Wojnarowska F. Autoimmune blistering diseases: an up-date of diagnostic methods and investigations. Clin Exp Dermatol 1994; 19:97-112. [PMID: 8050161 DOI: 10.1111/j.1365-2230.1994.tb01135.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- G Kirtschig
- Department of Dermatology, Churchill Hospital, Oxford, UK
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Taylor G, Venning V, Wojnarowska F. Bullous pemphigoid and associated autoimmune thrombocytopenia: two case reports. J Am Acad Dermatol 1993; 29:900-2. [PMID: 8408837 DOI: 10.1016/0190-9622(93)70266-v] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We describe two patients with bullous pemphigoid in whom autoimmune thrombocytopenia developed. Only one case of bullous pemphigoid associated with autoimmune thrombocytopenia has previously been reported, and in that case, autoimmune hemolytic anemia was also present (Evans' syndrome). However, a wide range of other autoimmune diseases have been described in association with bullous pemphigoid, and this literature is reviewed.
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Affiliation(s)
- G Taylor
- Department of Dermatology, Slade Hospital, Oxford, United Kingdom
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Stanley JR. Cell adhesion molecules as targets of autoantibodies in pemphigus and pemphigoid, bullous diseases due to defective epidermal cell adhesion. Adv Immunol 1993; 53:291-325. [PMID: 8512037 DOI: 10.1016/s0065-2776(08)60503-9] [Citation(s) in RCA: 220] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J R Stanley
- Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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Venning VA, Allen J, Aplin JD, Kirtschig G, Wojnarowska F. The distribution of alpha 6 beta 4 integrins in lesional and non-lesional skin in bullous pemphigoid. Br J Dermatol 1992; 127:103-11. [PMID: 1390136 DOI: 10.1111/j.1365-2133.1992.tb08040.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The alpha 6 beta 4 integrin is associated ultrastructurally with the hemidesmosomes of the basal keratinocytes and with the bullous pemphigoid antigen (BPA), suggesting an important role in adhesion of epidermal cells to the basement membrane. Using an immunofluorescence technique with chain-specific monoclonal antibodies to the alpha and beta subunits we have investigated the distribution of the alpha 6 beta 4 integrin in normal skin (n = 3) and in BP skin (uninvolved, perilesional and lesional) [n = 11]). The findings have been compared with other types of subepidermal blisters and with normal skin split by chemical means (n = 2) and by suction (n = 2). The distribution of alpha 6 beta 4 integrin was compared with that of bullous pemphigoid antigen (BPA) and with other basement membrane zone (BMZ) macromolecules, laminin, collagen type IV, collagen type VII and the BM600 antigen. In uninvolved, perilesional and early pre-blistered lesional BP skin the distribution of both the alpha 6 and beta 4 integrin subunits, BPA laminin, collagen types IV and VII and the BM600 antigen was identical to normal skin, i.e. a linear band in the BMZ. Within BP blisters, both alpha 6 and beta 4 integrin subunits and BPA were absent, except in two blisters in which the integrin expression was retained in the blister roof, despite loss of BPA. The other BMZ components were expressed on the blister floor.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V A Venning
- Department of Dermatology, Slade Hospital, Oxford, U.K
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