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Forster AM, Navarini A, Muehleisen B. Painful Mucocutaneous Blistering in a Young Male Patient: A Quiz. Acta Derm Venereol 2024; 104:adv40778. [PMID: 38916181 PMCID: PMC11223576 DOI: 10.2340/actadv.v104.40778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Anna-Maria Forster
- Departement of Dermatology and Venerology, University Hospital Basel, Basel.
| | - Alexander Navarini
- Departement of Dermatology and Venerology, University Hospital Basel, Basel
| | - Beda Muehleisen
- Departement of Dermatology and Venerology, University Hospital Basel, Basel
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Sriram S, Hasan S, Mansoori S, Saeed S, Banerjee A, Ramalingam K. Juvenile pemphigus vulgaris: Literature review and a rare case report. Clin Case Rep 2024; 12:e8954. [PMID: 38756617 PMCID: PMC11096281 DOI: 10.1002/ccr3.8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion affecting the skin and mucous membranes, predominantly affects females in their fifth and sixth decades of life. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. PV should always be considered in the differential diagnosis of oral ulcerative and vesiculobullous lesions in both children and adolescents.
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Affiliation(s)
| | - Shamimul Hasan
- Department of Oral Medicine and RadiologyFaculty of Dentistry, Jamia Millia IslamiaNew DelhiIndia
| | - Shahnaz Mansoori
- Department of Oral Medicine and RadiologyFaculty of Dentistry, Jamia Millia IslamiaNew DelhiIndia
| | - Shazina Saeed
- Amity Institute of Public Health & Hospital AdministrationAmity UniversityNoidaUttar PradeshIndia
| | - Abhishek Banerjee
- Oral and Maxillofacial PathologyAwadh Dental College and HospitalJamshedpurJharkhandIndia
| | - Karthikeyan Ramalingam
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
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Childhood Pemphigus Vulgaris during COVID-19 Outbreak Successfully Treated with Prednisone and Azathioprine: A Case Report and Literature Review. J Clin Med 2022; 11:jcm11226858. [PMID: 36431335 PMCID: PMC9696635 DOI: 10.3390/jcm11226858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION pemphigus vulgaris is a rare autoimmune blistering disease that involves the skin and mucous membranes and rarely occurs in pediatric age. METHODS we present a case of childhood pemphigus in a 9-year-old patient from Burkina Faso, which initially manifested with erosive lesions symmetrically distributed in the oral cavity. After a few months, we also observed hyperchromic lesions of the back. Histopathological examination of skin samples showed intraepidermal acantholysis, while direct immunofluorescence showed deposits of complement (C3) and immunoglobulins G (IgG) in the epidermidis; an ELISA test highlighted the presence of circulating autoantibodies against desmoglein 3. RESULTS the follow-up of this patient was made difficult by the advent of the COVID-19 outbreak. However, after about one year of combined therapy with systemic steroids and azathioprine the patient reached clinical remission.
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Moussaoui E, Oueslati Y, Oualha L, Denguezli M, Sriha B, Douki N. Simultaneous Oral and Umbilical Locations as a First Sign of Pemphigus Vulgaris. Case Rep Dent 2021; 2021:7792360. [PMID: 34733562 PMCID: PMC8560286 DOI: 10.1155/2021/7792360] [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: 05/22/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
The place of pemphigus vulgaris (PV) among autoimmune bullous diseases (AIBD) is well established. It is an acquired chronic, autoimmune, vesiculobullous disease in which IgG antibodies target desmosomal proteins to produce intraepithelial mucocutaneous blistering. The diagnosis is often challenging for the clinicians. It requires a combination of three major features: clinical, histopathological, and immunological. Clinically, oral lesions are the first manifestations of the disease in 50-90% of the patients with widespread blisters affecting the oral mucosa. On the skin, lesions are characterized by flaccid blisters that rapidly progress into erosions and crust formation. Umbilical lesions as a clinical manifestation of PV are peculiar and have rarely been reported, and they are not yet completely elucidated. Umbilical region involvement in patients with pemphigus was assessed in a limited study totalling just 10 patients. This localisation may be a valuable hint easing the diagnosis at the clinical level for patients with oral mucosal blisters. Dentists must be familiar with the clinical manifestations of PV to make an early diagnosis and start an early treatment which determines the prognosis of the disease. To the best of the authors' knowledge, the coexistence of these lesions with the oral lesions as a first sign of PV in the absence of skin involvement was reported in only one case of pemphigus vegetans (PVe). In this paper, we describe an observation of a female patient that was diagnosed with PV that begun with simultaneous oral and umbilical locations which coexisted for a period of 4 months before the appearance of other cutaneous lesions. We highlight the role of dentists, by being familiar with the clinical manifestations of PV, to make an early diagnosis to start an early treatment which determines the prognosis of the disease and to follow closely the evolution of lesions to change treatment if required. We also discuss the clinical, histological, and immunological features of the disease that enabled the differential diagnosis as well as the appropriate therapeutic management.
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Affiliation(s)
- Eya Moussaoui
- Department of Dental Medicine, Sahloul Hospital (Sousse), Dental Faculty of Monastir, University of Monastir, Tunisia
- Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11), University of Monastir, Tunisia
| | - Yassine Oueslati
- Department of Dental Medicine, Sahloul Hospital (Sousse), Dental Faculty of Monastir, University of Monastir, Tunisia
- Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11), University of Monastir, Tunisia
| | - Lamia Oualha
- Department of Dental Medicine, Sahloul Hospital (Sousse), Dental Faculty of Monastir, University of Monastir, Tunisia
- Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11), University of Monastir, Tunisia
| | - Mohamed Denguezli
- Dermatology Department, Farhat Hached Hospital (Sousse), University of Sousse, Tunisia
| | - Badreddine Sriha
- Cytology and Pathological Anatomy Department, Farhat Hached Hospital (Sousse), University of Sousse, Tunisia
| | - Nabiha Douki
- Department of Dental Medicine, Sahloul Hospital (Sousse), Dental Faculty of Monastir, University of Monastir, Tunisia
- Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11), University of Monastir, Tunisia
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Subadra K, S S, Warrier S A. Oral Pemphigus Vulgaris. Cureus 2021; 13:e18005. [PMID: 34671517 PMCID: PMC8521543 DOI: 10.7759/cureus.18005] [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: 09/15/2021] [Indexed: 11/05/2022] Open
Abstract
Pemphigus is a chronic mucocutaneous autoimmune disease with the clinical feature of blisters that initially appear in the oral cavity and later in the skin. The dental professionals play an important role in diagnosing the disease. Early diagnosis and treatment determine the course and prognosis of the disease. Systemic corticosteroids continue to be the standard therapy for pemphigus vulgaris (PV). Management of PV involves prolonged use of steroids to control the disease and prevent relapses, but associated adverse events constantly remain a great challenge. Regular periodic clinical evaluation of patients with pemphigus on steroids is mandatory. This article describes a case of a 50-year-old woman with multiple chronic ulcers in the oral cavity in whom the diagnosis of PV was made and treated. The case study is followed by a review of the literature including etiology, pathogenesis, clinical features, as well as the various diagnostic criteria and the therapeutic options of PV.
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Affiliation(s)
- K Subadra
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sathasivasubramanian S
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Aravind Warrier S
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Lins GT, Barbosa NLS, de Abreu EMV, da Costa KVT, Meneses KCB, Silva RN, Ferreira SMS. Childhood pemphigus vulgaris is a challenging diagnosis. Autops Case Rep 2021; 11:e2021267. [PMID: 34307224 PMCID: PMC8294838 DOI: 10.4322/acr.2021.267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Pemphigus Vulgaris (PV) is an uncommon autoimmune and blistering mucocutaneous disease. Childhood Pemphigus Vulgaris (CPV) is a pediatric variant of PV, which affects children below 12 years, being very rare among children under 10 years of age. CPV has similar clinical, histological, and immunological features as seen in PV in adults. The mucocutaneous clinical presentation is the most common in both age groups. Vesicles and erosions arising from the disease usually cause pain. A few CPV cases have been reported in the literature. This study reports a case of an 8-year-old male patient with oral lesions since the age of 3 years, and the diagnosis of pemphigus was achieved only 2 years after the appearance of the initial lesions. CPV remains a rare disease, making the diagnosis of this clinical case a challenge due to its age of onset and clinical features presented by the patient. Therefore, dentists and physicians should know how to differentiate CPV from other bullous autoimmune diseases more common in childhood.
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Affiliation(s)
| | | | | | | | - Kelly Chrystine Barbosa Meneses
- Centro Universitário CESMAC, Curso de Medicina, Maceió, AL, Brasil.,Centro Universitário CESMAC, Mestrado Profissional Pesquisa em Saúde, Maceió, AL, Brasil
| | - Rodrigo Neves Silva
- Centro Universitário CESMAC, Curso de Odontologia, Maceió, AL, Brasil.,Centro Universitário CESMAC, Mestrado Profissional Pesquisa em Saúde, Maceió, AL, Brasil.,Centro Universitário CESMAC, Laboratório de Patologia oral, Maceió, AL, Brasil
| | - Sonia Maria Soares Ferreira
- Centro Universitário CESMAC, Curso de Odontologia, Maceió, AL, Brasil.,Centro Universitário CESMAC, Mestrado Profissional Pesquisa em Saúde, Maceió, AL, Brasil.,Posto de Atendimento Médico Salgadinho-Serviço de Estomatologia, Maceió, AL, Brasil
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Gue S, Huang G, Moore L, Hammond P, Boros CA. Pemphigus Vulgaris and Eosinophilic Esophagitis in a 13-Year-Old Boy: Case Report and Review of the Literature. Pediatr Dermatol 2017; 34:e80-e84. [PMID: 28297154 DOI: 10.1111/pde.13086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This case report presents a 13-year-old boy referred to the Department of Paediatric Dentistry, Women's and Children's Hospital, Adelaide, South Australia, Australia, with a 5-week history of severe oral ulcerations and significant weight loss of unknown origin. The diagnosis of pemphigus vulgaris was made after histologic and immunofluorescent examination of an intraoral deep incisional biopsy, with eosinophilic esophagitis also diagnosed during the initial upper gastrointestinal endoscopy. The association between pemphigus vulgaris and eosinophilic esophagitis in this case, although previously unreported, is explicable on the basis of dysregulation of desmoglein 1 (DSG1). This case report identifies a new clinical association that could help clinicians identify further such cases and provides insight into the pathogenesis of both conditions.
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Affiliation(s)
- Sumant Gue
- Department of Paediatric Dentistry, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatric Dentistry, School of Dentistry, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Gwendolyn Huang
- Discipline of Paediatric Dentistry, School of Dentistry, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Division of Paediatric Surgery, Department of Paediatric Dentistry, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lynette Moore
- Department of Surgical Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,University Discipline of Pathology, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Hammond
- Department of Paediatric Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Christina A Boros
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.,Department of Paediatric Rheumatology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Abstract
INTRODUCTION Pemphigus vulgaris (PV) is a chronic, autoimmune, vesiculobullous disease. As a result of the relative rarity of PV, published randomized controlled trials (RCTs) are limited, which makes it difficult to evaluate the efficacy of different treatment regimens in this disease. This also precludes conduct of a meta-analysis. METHODS English-language publications describing treatment outcomes of patients with PV were identified by searches of electronic databases through May 2015, and additionally by review of the bibliography of these publications. A total of 89 papers, which included 21 case reports, 47 case series, 8 RCTs, and 13 observational studies, were identified. The findings from these publications, including information on disease course and prognosis, medications used, treatment responses, and side effects, are summarized in the tables and text of this review. RESULTS Prior to availability of corticosteroid therapy, PV had a high fatality rate. Early publications from the 1970s reported high-dose, prolonged corticosteroid use and significant associated side effects. Later reports described use of corticosteroids along with steroid-sparing adjuvants, which allows a reduction in the total dose of corticosteroids and a reduction in observed mortality and morbidity. For the majority of patients in these reports, a long-term course on medications lasting about 5-10 years was observed; however, subgroups of patients requiring shorter courses or needing longer-term therapy have also been described. Early diagnosis of PV and early initiation of treatment were prognostic factors. In recent publications, commonly used initial regimens include corticosteroids in combination with mycophenolate or azathioprine; whereas, for patients with inadequate response to these regimens, adjuvants such as intravenous immunoglobulin (IVIg) or rituximab are used. CONCLUSION The review findings emphasize the importance of early diagnosis, early initiation of treatment, and use of steroid-sparing adjuvants to allow a reduced total dose and duration on corticosteroids. Also highlighted is the need for more RCTs.
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Hayes E, Challacombe SJ. An Overview of Vesicobullous Conditions Affecting the Oral Mucosa. Prim Dent J 2016; 5:46-50. [PMID: 29029653 DOI: 10.1177/205016841600500105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vesicobullous diseases are characterised by the presence of vesicles or bullae at varying locations in the mucosa. The most common occurring in the oral cavity are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both are autoimmune diseases with a peak age onset of over 60 years and females are more commonly affected than men. This paper reviews the structure of the oral mucosa, with specific reference to the basement membrane zone, as well as bullous conditions affecting the mucosa, including PV and pemphigoid, their aetiology, clinical presentation, and management.
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Affiliation(s)
- Emma Hayes
- Oral and Maxillofacial Surgery, St George's Hospital, London, UK
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Abstract
Desmosomes are cell-cell junctions that mediate adhesion and couple the intermediate filament cytoskeleton to sites of cell-cell contact. This architectural arrangement integrates adhesion and cytoskeletal elements of adjacent cells. The importance of this robust adhesion system is evident in numerous human diseases, both inherited and acquired, which occur when desmosome function is compromised. This review focuses on autoimmune and infectious diseases that impair desmosome function. In addition, we discuss emerging evidence that desmosomal genes are often misregulated in cancer. The emphasis of our discussion is placed on the way in which human diseases can inform our understanding of basic desmosome biology and in turn, the means by which fundamental advances in the cell biology of desmosomes might lead to new treatments for acquired diseases of the desmosome.
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Altin N, Ergun S, Katz J, Sancakli E, Koray M, Tanyeri H. Implant-Supported Oral Rehabilitation of a Patient with Pemphigus Vulgaris: A Clinical Report. J Prosthodont 2013; 22:581-586. [DOI: 10.1111/jopr.12050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nazlı Altin
- Department of Oral Surgery; Istanbul University, Faculty of Dentistry; Istanbul Turkey
| | - Sertan Ergun
- Associate Professor, Department of Oral Surgery; Istanbul University, Faculty of Dentistry; Istanbul Turkey
| | - Joseph Katz
- Professor, Department of Oral and Maxillofacial Diagnostic Sciences University of Florida; College of Dentistry; Gainesville FL
| | - Erkan Sancakli
- Associate Professor, Department of Prosthodontics; Istanbul University, Faculty of Dentistry; Istanbul Turkey
| | - Meltem Koray
- Department of Oral Surgery; Istanbul University, Faculty of Dentistry; Istanbul Turkey
| | - Hakkı Tanyeri
- Professor, Department of Oral Surgery; Istanbul University, Faculty of Dentistry; Istanbul Turkey
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Abstract
Pemphigus vulgaris (PV) is a rare, potentially fatal chronic autoimmune disease of the skin and mucous membrane. The objective of this study was to analyze the clinical outcomes and side effects associated with treatment of childhood PV (CPV). A retrospective review of the English language literature was conducted through PUBMED using the words childhood pemphigus vulgaris, and treatment or clinical outcome. Only patients under 12 years of age were included. Thirty-three cases were found in 29 reports. Mean age at onset was 8.3 years (range 1.5-12 yrs). Mucosal involvement (97.0%) was more common than cutaneous involvement (84.8%). Oral mucosa was the most common site of mucosal involvement (93.9%), followed by genital (20.6%), ocular (11.8%), and nasal mucosa (2.9%). Mean duration of therapy was 4.5 years (range 0.6-14.5 yrs), and mean duration of follow-up was 5.2 years (range 0.6-16 yrs). Complete recovery with no further therapy was achieved in 18.2% and partial recovery with minor relapses while on maintenance therapy in 78.8%. One patient died due to infection (3.0%). Serious side effects were present in 60.6%. The most common were cushingoid features (65.0%), growth retardation (50.0%), and infection (50.0%). Two patients who were refractory to systemic corticosteroids and immunosuppressive agents (ISA) had a favorable clinical response to Rituximab. Current therapy for CPV involving the use of long-term systemic corticosteroids in conjunction with ISA results in prolonged immunosuppression, causing systemic infections and growth retardation. Safer and more effective therapies need to be explored.
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Affiliation(s)
- Dalia Mabrouk
- Center for Blistering Diseases, New England Baptist Hospital, Boston, Massachusetts 02120, USA
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Lo Russo L, Fedele S, Guiglia R, Ciavarella D, Lo Muzio L, Gallo P, Di Liberto C, Campisi G. Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis. J Periodontol 2008; 79:4-24. [DOI: 10.1902/jop.2008.070231] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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