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Chen Z, Wang L, Ma L, Yang F, Chen S, Yang J, Gao H, Tang C, Zhao Y, Zhang Z, Tang L, Xue H, Ying J, Xu Y, Zhang W, Shao L, Liu H, Luo X. Epidemiological Insights into Autoimmune Bullous Diseases in China: A Comprehensive Analysis. J Epidemiol Glob Health 2024:10.1007/s44197-024-00277-7. [PMID: 39037699 DOI: 10.1007/s44197-024-00277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE This study aims to conduct an extensive analysis of autoimmune bullous diseases, particularly pemphigus vulgaris and bullous pemphigoid, in Shanghai, China, from 2016 to 2023. It seeks to understand the demographic profiles, comorbidities, mortality rates, risk factors, and socioeconomic impacts associated with autoimmune bullous disease. METHODS A cross-sectional study design was employed, enrolling 1,072 patients. Diagnostic measures included clinical manifestations, histopathology, direct immunofluorescence, and serologic tests. The study also involved a detailed socioeconomic analysis and evaluation of occupational risks. RESULTS The findings highlight a significant occupational risk in industries requiring enhanced safety measures, with a notable prevalence of autoimmune bullous disease among workers in these sectors. A considerable portion of the patients were from low-income backgrounds with limited literacy, indicating the economic burden of autoimmune bullous disease. A key discovery of the study is the potential pathological link between autoimmune bullous disease and interstitial lung disease. CONCLUSION This research, one of the first comprehensive studies on autoimmune bullous disease in China, underscores the need for targeted healthcare strategies and further investigation into autoimmune bullous disease, particularly its relationship with interstitial lung disease.
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Affiliation(s)
- Zihua Chen
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Lanting Wang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Li Ma
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Fanping Yang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Shengan Chen
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Jin Yang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Haiqing Gao
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Chang Tang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Ying Zhao
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Zhen Zhang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Lin Tang
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Haiyu Xue
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Jian Ying
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Yu Xu
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Allergy and Immunology, Department of Dermatology, Research Center of Allergy and Diseases, Huashan Hospital Affiliated to Fudan University, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, P.R. China.
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Caux F, Patsatsi A, Karakioulaki M, Antiga E, Baselga E, Borradori L, Caproni M, Cardones AR, Chandran NS, Dräger S, Drenovska K, Goebeler M, Günther C, Hofmann SC, Ioannides D, Joly P, Marinović B, Mariotti EB, Marzano AV, Morel KD, Murrell DF, Prost C, Sárdy M, Setterfield J, Skiljevic D, Uzun S, Vassileva S, Zambruno G, Schmidt E. S2k guidelines on diagnosis and treatment of linear IgA dermatosis initiated by the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol 2024; 38:1006-1023. [PMID: 38421060 DOI: 10.1111/jdv.19880] [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: 10/06/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Linear IgA dermatosis (LAD) is a rare subepidermal autoimmune bullous disease (AIBD) defined by predominant or exclusive immune deposits of immunoglobulin A at the basement membrane zone of skin or mucous membranes. This disorder is a rare, clinically and immunologically heterogeneous disease occurring both in children and in adults. The aim of this project is to present the main clinical features of LAD, to propose a diagnostic algorithm and provide management guidelines based primarily on experts' opinion because of the lack of large methodologically sound clinical studies. METHODS These guidelines were initiated by the European Academy of Dermatology and Venereology (EADV) Task Force Autoimmune Bullous Diseases (AIBD). To achieve a broad consensus for these S2k consensus-based guidelines, a total of 29 experts from different countries, both European and non-European, including dermatologists, paediatric dermatologists and paediatricians were invited. All members of the guidelines committee agreed to develop consensus-based (S2k) guidelines. Prior to a first virtual consensus meeting, each of the invited authors elaborated a section of the present guidelines focusing on a selected topic, based on the relevant literature. All drafts were circulated among members of the writing group, and recommendations were discussed and voted during two hybrid consensus meetings. RESULTS The guidelines summarizes evidence-based and expert opinion-based recommendations (S2 level) on the diagnosis and treatment of LAD. CONCLUSION These guidelines will support dermatologists to improve their knowledge on the diagnosis and management of LAD.
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Affiliation(s)
- Frédéric Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP and University Paris 13, Bobigny, France
| | - Aikaterini Patsatsi
- Autoimmune Bullous Diseases Unit, 2nd Department of Dermatology, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Meropi Karakioulaki
- Department of Dermatology and Venereology, Medical Center, University Hospital Freiburg, Freiburg, Germany
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, Azienda USL Toscana Centro, Rare Diseases Unit, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Eulalia Baselga
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Luca Borradori
- Department of Dermatology, University of Bern, Inselspital, Berne, Switzerland
| | - Marzia Caproni
- Department of Health Sciences, Section of Dermatology, Azienda USL Toscana Centro, Rare Diseases Unit, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Adela R Cardones
- Division of Dermatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sören Dräger
- Department of Dermatology, Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Kossara Drenovska
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University-Sofia, Sofia, Bulgaria
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital, Technical University Dresden, Dresden, Germany
| | - Silke C Hofmann
- Department of Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Dimitrios Ioannides
- 1st Department of Dermatology, Aristotle University School of Medicine, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, INSERM 1234, Normandie University, Rouen, France
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Elena Biancamaria Mariotti
- Department of Health Sciences, Section of Dermatology, Azienda USL Toscana Centro, Rare Diseases Unit, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Kimberly D Morel
- Departments of Dermatology and Pediatrics at Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Prost
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP and University Paris 13, Bobigny, France
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Jane Setterfield
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UK
| | - Dusan Skiljevic
- Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Soner Uzun
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Snejina Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University-Sofia, Sofia, Bulgaria
| | - Giovanna Zambruno
- Genodermatosis Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enno Schmidt
- Department of Dermatology, Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Sneha Muppala R, Basavaraj V. Role of C4d immunohistochemical marker in the diagnosis of bullous pemphigoid: A cross-sectional study. Indian J Dermatol Venereol Leprol 2024; 0:1-6. [PMID: 38595011 DOI: 10.25259/ijdvl_124_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/15/2023] [Indexed: 04/11/2024]
Abstract
Objective To determine the diagnostic utility of C4d immunohistochemical marker in cases of bullous pemphigoid by calculating the sensitivity, specificity, positive predictive value and negative predictive value. Methods We conducted an exploratory study (retrospectively and prospectively) from January 2017 to June 2022. All direct immunofluorescence proven cases of bullous pemphigoid were included in the study while cases with inadequate tissue for immunohistochemistry studies were excluded. Results Among the 57 cases of bullous pemphigoid, 49 showed positivity for C4d marker. All the ten control cases of inflammatory dermatoses were negative for C4d staining. A sensitivity of 86%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 55.56% were calculated with a confidence interval of 95%. Conclusion Direct immunofluorescence on fresh or frozen skin tissue remains the gold standard. But in circumstances where direct immunofluorescence facilities are not available, C4d immunohistochemistry marker staining on formalin-fixed paraffin-embedded material submitted for standard microscopic investigation can, in most cases, confirm the diagnosis of bullous pemphigoid, obviating the need for a second biopsy. Limitation It is a single centre study. Selection bias may come into play.
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Affiliation(s)
- Raaga Sneha Muppala
- Department of Pathology, Jagadguru Sri Shivarathreeshwara Medical College, JSS Academy of Higher Education and Research, Mysuru, India
| | - Vijaya Basavaraj
- Department of Pathology, Jagadguru Sri Shivarathreeshwara Medical College, JSS Academy of Higher Education and Research, Mysuru, India
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Timóteo RP, Pessoa-Gonçalves YM, do Carmo Neto JR, Rodrigues WF, da Silva MV, Oliveira CJF. A Global View of Pemphigus: Geographical Variations. Clin Rev Allergy Immunol 2024; 66:14-29. [PMID: 38289514 DOI: 10.1007/s12016-024-08980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/28/2024]
Abstract
Pemphigus, an autoimmune intraepidermal bullous disease group with roughly eight distinct forms, includes pemphigus vulgaris (PV) and pemphigus foliaceus (PF) as its predominant global forms. Despite the increased utilization of global health records and reporting systems, epidemiological data remain limited and poorly categorized. Therefore, this study aimed to conduct a review to track, identify, and characterize cases of PV and PF published and categorized worldwide. A research question was formulated; studies were selected based on the inclusion criteria; and data from these publications were systematically collected, summarized, and presented using narrative descriptions. The search strategy yielded 3,212 articles, of which 95 underwent critical analysis and data extraction. Studies from 52 countries contributed to the dataset, covering various pemphigus variants. Notably, only two countries, Iran (18.87%) and South Korea (11.43%), accounted for approximately a third of the reported PV cases, while Brazil contributed 40.25% of the foliaceus variants cases documented in the literature. These findings offer valuable insights into the global distribution of pemphigus and inform future research and healthcare efforts.
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Affiliation(s)
- Rodolfo Pessato Timóteo
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Yago Marcos Pessoa-Gonçalves
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - José Rodrigues do Carmo Neto
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, 74690-900, Brazil
| | - Wellington Francisco Rodrigues
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Marcos Vinícius da Silva
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Carlo José Freire Oliveira
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil.
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Subahi G, Waheeb S, Binmadi N, Almazrooa S, Akeel S, Öhman J, Dafar A. Erythema multiforme-like lip presentation in pemphigus vulgaris patients: a multicenter case series. BMC Oral Health 2023; 23:952. [PMID: 38041037 PMCID: PMC10693153 DOI: 10.1186/s12903-023-03665-w] [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: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous blistering disease. Autoantibodies are directed against desmogleins, leading to the formation of intraepithelial bullae. PV, as with other autoimmune mucocutaneous disorders of the oral cavity, presents diagnostic and therapeutic challenges. Approximately 50-70% of cases present first with oral lesions. The lesions commonly start as vesicles or bullae that rapidly rupture, leading to erosions and ulcerations. The palatal, gingival, buccal, and labial mucosa are the most commonly affected sites. Oral PV can mimic several other diseases that cause mucosal erosions and/or ulcerations, including erythema multiforme (EM). EM is an acute, immune-mediated, self-limited hypersensitivity condition primarily associated with herpes simplex infection. Oral lesions can be variable, but a very characteristic presentation with labial hemorrhagic erosions, ulcerations and crusting is commonly seen. In this case series, we present six cases of PV: one male patient and five female patients whose ages ranged from 34 to 65 years old. All patients presented with hemorrhage and crusting of the lips in addition to multiple intraoral erosions and ulcerations. Three patients presented with oral and skin lesions. All patients underwent biopsies, and a diagnosis of PV was confirmed. All patients were treated with steroids (topical and systemic) and variable steroid-sparing agents. This case series emphasizes that oral PV may be misdiagnosed as EM in a subgroup of patients who present with persistent lip hemorrhage and crusting. Therefore, a comprehensive history, clinical examination and incisional biopsies should be considered in such patients.
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Affiliation(s)
- Ghidaa Subahi
- Oral Medicine and Pathology Saudi Board Program, Jeddah, Saudi Arabia
| | | | - Nada Binmadi
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soulafa Almazrooa
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Akeel
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amal Dafar
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia.
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Leisti P, Pankakoski A, Jokelainen J, Varpuluoma O, Huilaja L, Panelius J, Tasanen K. Accurate diagnosis of bullous pemphigoid requires multiple health care visits. Front Immunol 2023; 14:1281302. [PMID: 38090583 PMCID: PMC10711056 DOI: 10.3389/fimmu.2023.1281302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Accurate use of diagnostic codes is crucial for epidemiological and genetic research based on electronic health record (EHR) data. Methods This retrospective study validated the International Classification of Diseases (ICD)-10 diagnostic code L12.0 for bullous pemphigoid (BP) using EHR data from two Finnish university hospitals. We found 1225 subjects with at least one EHR entry of L12.0 between 2009 and 2019. BP diagnosis was based on clinical findings characteristic of BP and positive findings on direct immunofluorescence (DIF), BP180-NC16A enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence (IIF) assay. Results True BP was found in 901 patients; the positive predictive value (PPV) for L12.0 was 73.6% (95% CI 71.0-76.0). L12.0 was more accurately registered in dermatology units than any specialized health care units (p<0.001). Including patients with multiple L12.0 registrations (≥3), increased the accuracy of the L12.0 code in both dermatology units and other settings. Discussion One diagnostic code of L12.0 is not enough to recognize BP in a large epidemiological data set; including only L12.0 registered in dermatology units and excluding cases with <3 L12.0 record entries markedly increases the PPV of BP diagnosis.
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Affiliation(s)
- Päivi Leisti
- Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna Pankakoski
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Jokelainen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Outi Varpuluoma
- Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Laura Huilaja
- Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaana Panelius
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Tasanen
- Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Rosi-Schumacher M, Baker J, Waris J, Seiffert-Sinha K, Sinha AA. Worldwide epidemiologic factors in pemphigus vulgaris and bullous pemphigoid. Front Immunol 2023; 14:1159351. [PMID: 37180132 PMCID: PMC10166872 DOI: 10.3389/fimmu.2023.1159351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Autoimmune blistering diseases such as bullous pemphigoid (BP) and pemphigus vulgaris (PV) are complex, multifactorial, and polygenic diseases, whose exact pathogenesis is difficult to pinpoint. Research aimed at elucidating the associated epidemiologic risk factors of these two diseases has been hampered by their rare disease status. Further, a lack of centralization and standardization of available data makes the practical application of this information challenging. In order to collate and clarify the available literature we comprehensively reviewed 61 PV articles from 37 different countries and 35 BP articles from 16 different countries addressing a range of disease relevant clinical parameters including age of onset, sex, incidence, prevalence, and HLA allele association. The reported incidence of PV ranged from 0.098 to 5 patients per 100,000 people, while BP ranged from 0.21 to 7.63 patients per 100,000. Prevalence of PV ranged from 0.38 to 30 per 100,000 people and BP ranged from 1.46 to 47.99 per 100,000. The mean age of onset in patients ranged from 36.5 to 71 years for PV and 64 to 82.6 years for BP. Female-to-male ratios ranged from 0.46 to 4.4 in PV and 1.01 to 5.1 in BP. Our analysis provides support for the reported linkage disequilibrium of HLA DRB1*0402 (an allele previously shown to be associated with PV) and DQB1*0302 alleles in Europe, North America, and South America. Our data also highlight that HLA DQB1*0503 (also known to be associated with PV) appears in linkage disequilibrium with DRB1*1404 and DRB1*1401, mainly in Europe, the Middle East, and Asian countries. The HLA DRB1*0804 allele was only associated with PV in patients of Brazilian and Egyptian descent. Only two HLA alleles were reported as associated with BP more than twice in our review, DQB1*0301 and DQA1*0505. Collectively, our findings provide detailed insights into the variation of disease parameters relevant to PV and BP that can be expected to inform future work aimed at unraveling the complex pathogenesis of these conditions across the globe.
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Affiliation(s)
| | | | | | | | - Animesh A. Sinha
- Department of Dermatology, University at Buffalo, Buffalo, NY, United States
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Opelka B, Schmidt E, Goletz S. Type XVII collagen: Relevance of distinct epitopes, complement-independent effects, and association with neurological disorders in pemphigoid disorders. Front Immunol 2022; 13:948108. [PMID: 36032160 PMCID: PMC9400597 DOI: 10.3389/fimmu.2022.948108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Pemphigoid diseases (PD) are autoimmune skin blistering diseases characterized by autoantibodies directed against proteins of the cutaneous basement membrane zone (BMZ). One of the major antigens is type XVII collagen (BP180), a transmembrane glycoprotein, which is targeted in four PDs: bullous pemphigoid, mucous membrane pemphigoid, linear IgA dermatosis, and pemphigoid gestationis. To date, different epitopes on BP180 have been described to be recognized by PD disease patients’ autoantibodies. Different BP180 epitopes were associated with distinct clinical phenotypes while the underlying mechanisms are not yet fully understood. So far, the main effects of anti-BP180 reactivity are mediated by Fcγ-receptors on immune cells. More precisely, the autoantibody–antigen interaction leads to activation of complement at the BMZ and infiltration of immune cells into the upper dermis and, by the release of specific enzymes and reactive oxygen species, to the degradation of BP180 and other BMZ components, finally manifesting as blisters and erosions. On the other hand, inflammatory responses independent of Fcγ-receptors have also been reported, including the release of proinflammatory cytokines and internalization and depletion of BP180. Autoantibodies against BP180 can also be found in patients with neurological diseases. The assumption that the clinical expression of PD depends on epitope specificity in addition to target antigens, autoantibody isotypes, and antibody glycosylation is supported by the observation that epitopes of PD patients differ from those of PD patients. The aim of the present review is to describe the fine specificities of anti-BP180 autoantibodies in different PDs and highlight the associated clinical differences. Furthermore, the direct effects after binding of the autoantibodies to their target are summarized.
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Affiliation(s)
- Bianca Opelka
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- *Correspondence: Stephanie Goletz,
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Kharayat V, Vasudevan B, Lekshmi Priya K, Verma R, Dev P, Deora M. An observational study to determine the role of indirect immunofluorescence and ELISA for desmogleins in the diagnosis and monitoring of autoimmune bullous disorders. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Epidemiologic Study of Patients with Chronic Vesiculobullous Lesions. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Lu L, Chen L, Xu Y, Liu A. Global Incidence and Prevalence of Bullous Pemphigoid: a Systematic Review and meta-analysis. J Cosmet Dermatol 2022; 21:4818-4835. [PMID: 35080093 DOI: 10.1111/jocd.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Integrated information on the global prevalence and incidence of bullous pemphigoid (BP) is lacking. OBJECTIVE To estimate the incidence and prevalence of BP in a systematic review and meta-analysis. METHODS Observational studies were included by using databases of Medline, EMBASE and Cochrane Library. Subgroup analysis was by continent, age, sex and country income level. Random-effects model was used. Between-study heterogeneity was assessed using the I2 statistic. RESULTS The global incidence was 0.0419 per 1000 person-years (95% CI: 0.0414-0.0424). The incidence was 0.047 per 1000 person-years (95% CI: 0.0462-0.0477), 0.0419 per 1000 person-years (95% CI: 0.0411-0.0426), 0.0072 per 1000 person-years (95% CI: 0.0067-0.0078), 0.003 per 1000 person-years (95% CI: 0.0023-0.0039) in North America, Europe, Asia and Africa, respectively; 0.0202 per 1000 person-years (95% CI: 0.0196; 0.0208) and 0.0181 per 1000 person-years (95% CI: 0.0175; 0.0188) females and males; 0.001 per 1000 person-years (95% CI: 0.001-0.001), 0.002 per 1000 person-years (95% CI:0.001-0.002), 0.004 per 1000 person-years (95% CI: 0.004-0.004); 0.007 per 1000 person-years (95% CI: 0.007-0.008), 0.011 per 1000 person-years (95% CI: 0.011-0.012), 0.017 per 1000 person-years (95% CI: 0.015-0.018) for age < 50, 50-59, 60-69, 70-79, 80-89 and ≥90 years. 0.0038 per 1000 person-years (95% CI:0.0036-0.004112) (I2 = 99%, p<.05) and 0.0456 per 1000 person-years (95% CI:0.0450-0.0462) (I2 = 100%, p<.05). The pooled clinic-based prevalence was 0.79 % (95% CI: 0.75%-0.84%), and 1.13% (95% CI: 1.06%-1.21%), 0.21% (95% CI: 0.17%-0.26%), 0.13% (95% CI:0.1%-0.15%) for Asia, Africa and Europe. CONCLUSIONS This study identified the global incidence and prevalence of BP in terms of spatial and population distributions and among various income level. A relatively higher incidence was in Europe, females, older people and high-income level country. The prevalence was higher in Asia. These findings should be interpreted with caution due to high heterogeneity of included studies.
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Affiliation(s)
- Lingling Lu
- Henan University of Chinese Medicine, Zhengzhou, P.R. China
| | - Linjiao Chen
- Department of dermatology, Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, P.R.China
| | - Yujuan Xu
- Department of Gynae Cology and Obstetrics, Changshu Hospital of Chinese Medicine, Suzhou, P.R.China
| | - Aimin Liu
- Department of Dermatology, Henan Province Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, P.R.China
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Durdu M, Bozca BC, Enli S, Yazıcı Özgen Z, Yaylı S, Aktan Ş, Mutlu D, Erturan I, Ayvaz Çelik HH, Melikoğlu M, Pala E, Gürsel Ürün Y, Harman M, Şavk E, Işık S, Duygulu Ş, İmren IG, Fettahlıoğlu Karaman B, Kaya Erdoğan H, Kılıç A, Özçelik S, Inan K, Yılmaz MA, Şanlı HE, Kalay Yıldızhan İ, Mülayim MK, Çiçek D, Demir B, Yasak Güner R, Baykal Selçuk L, Gündüz K, Daye M, Borlu M, Solak EO, Dizman D, Güneş B, Ozkur E, Polat M, Eskiocak AH, Uzun S. A multicentre prospective analysis of the incidence of pemphigoid diseases in Turkey. Australas J Dermatol 2021; 62:e496-e503. [PMID: 34642934 DOI: 10.1111/ajd.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The differentiation between the pemphigoid diseases is essential for treatment and prognosis. In Turkey, data on the incidence of these diseases are insufficient. Our aim in this study is to determine the incidence, demographics and clinical characteristics associated with diseases of the pemphigoid group. METHODS We prospectively analysed 295 patients with pemphigoid who visited dermatology clinics of tertiary referral hospitals in 12 different regions of Turkey within a year. The diagnosis was based on clinical, histopathological, direct immunofluorescence (DIF) and serological (multivariant enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence and mosaic-based BIOCHIP) examinations. Clinical and demographic findings, aetiological factors and concomitant diseases observed in the patients were recorded. RESULTS A total of 295 (female/male ratio: 1.7/1) patients with pemphigoid were diagnosed in 1-year period. The overall incidence rate of pemphigoid diseases was found to be 3.55 cases per million-years. The ratio of pemphigoid group diseases to pemphigus group diseases was 1.6. The most common pemphigoid type was bullous pemphigoid (BP, 93.2%). The others were epidermolysis bullosa acquisita (3.1%), pemphigoid gestationis (2.4%), linear IgA disease (1%) and mucous membrane pemphigoid (0.3%). The most common (26.8%) possible trigger of the bullous pemphigoid was gliptin derivative drugs. The most common concomitant diseases with pemphigoid were cardiovascular (27.8%) and neurological diseases (23.7%). CONCLUSIONS This study showed that the increased frequency of bullous pemphigoid reversed the pemphigoid/pemphigus ratio in Turkey. Further studies are warranted regarding the reasons for this increase.
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Affiliation(s)
- Murat Durdu
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Burçin Cansu Bozca
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Servinaz Enli
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Züleyha Yazıcı Özgen
- Department of Dermatology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Savaş Yaylı
- Faculty of Medicine, Department of Dermatology, Karadeniz Technical University, Trabzon, Turkey
| | - Şebnem Aktan
- Department of Dermatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Derya Mutlu
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ijlal Erturan
- Department of Dermatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Havva Hilal Ayvaz Çelik
- Department of Dermatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Melikoğlu
- Department of Dermatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Erdal Pala
- Department of Dermatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Yıldız Gürsel Ürün
- Department of Dermatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mehmet Harman
- Department of Dermatology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Ekin Şavk
- Department of Dermatology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Selin Işık
- Department of Dermatology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Şeniz Duygulu
- Department of Dermatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Işıl Göğem İmren
- Department of Dermatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | | | - Hilal Kaya Erdoğan
- Department of Dermatology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Arzu Kılıç
- Department of Dermatology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Sinan Özçelik
- Department of Dermatology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Kıymet Inan
- Department of Dermatology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Mustafa Anıl Yılmaz
- Department of Dermatology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Hatice Erdi Şanlı
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Mehmet Kamil Mülayim
- Department of Dermatology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Demet Çiçek
- Department of Dermatology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Betül Demir
- Department of Dermatology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Rukiye Yasak Güner
- Department of Dermatology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Leyla Baykal Selçuk
- Faculty of Medicine, Department of Dermatology, Karadeniz Technical University, Trabzon, Turkey
| | - Kamer Gündüz
- Faculty of Medicine, Department of Dermatology, Celal Bayar University, Manisa, Turkey
| | - Munise Daye
- Department of Dermatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Murat Borlu
- Faculty of Medicine, Department of Dermatology, Erciyes University, Kayseri, Turkey
| | - Eda Oksum Solak
- Faculty of Medicine, Department of Dermatology, Erciyes University, Kayseri, Turkey
| | - Didem Dizman
- Faculty of Medicine, Department of Dermatology, Bezmialem Vakif University, İstanbul, Turkey
| | - Begüm Güneş
- Faculty of Medicine, Department of Dermatology, Bezmialem Vakif University, İstanbul, Turkey
| | - Ezgi Ozkur
- Department of Dermatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mualla Polat
- Faculty of Medicine, Department of Dermatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Ali Haydar Eskiocak
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Soner Uzun
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Persson MSM, Begum N, Grainge MJ, Harman KE, Grindlay D, Gran S. The global incidence of bullous pemphigoid: a systematic review and meta-analysis. Br J Dermatol 2021; 186:414-425. [PMID: 34480482 DOI: 10.1111/bjd.20743] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering disorder that mainly affects older people. Although the disease is associated with considerable morbidity and mortality, the burden of disease worldwide is unclear. OBJECTIVES The study aim is to pool the global incidence of BP and determine whether this varies according to geographic area, age group, setting and study quality. METHODS Ovid MEDLINE, Ovid Embase and grey literature were systematically searched on 7 April 2020. Two reviewers independently screened, extracted data and appraised each study's quality using the Joanna Briggs Institute critical appraisal tool. Two domains, indicative of selection and survey bias, were used to identify high-quality studies. The cumulative incidence was standardized to 1 year and pooled in a random-effects meta-analysis. Subgroup and sensitivity analyses were conducted. RESULTS Twenty-seven studies were identified, of which 23 provided cumulative incidence and four provided incidence rates. The cumulative incidence of BP was 8·2 [95% confidence interval (CI) 4·8-13.7] per million people whereas the incidence rate was 34·2 (95% CI 19·2-60·7) per million person-years. Of the continents that contributed more than one study, the cumulative incidence was 10·3 (95% CI 5·8-18·2) and 5·6 (95% CI 3·5-9·0) per million people in Europe and Asia, respectively. The incidence was highest in studies including adults only (n = 2), in population-based studies (n = 9) and in more recent years. The cumulative incidence was higher (13·3 per million people, 95% CI 6·0-29·5) when restricting the analysis to higher-quality studies (n = 11). High heterogeneity (I2 > 82%) was observed across all pooled estimates. CONCLUSIONS The incidence of BP varies globally, is generally low but appears to be increasing over time. The burden of disease is likely to be underestimated.
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Affiliation(s)
| | - N Begum
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - M J Grainge
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - K E Harman
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - D Grindlay
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S Gran
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Hamad L, Kreidieh K, Hamdan MB, Nakouzi G, Yazbek S. Mapping the Diverse Genetic Disorders and Rare Diseases Among the Syrian Population: Implications on Refugee Health and Health Services in Host Countries. J Immigr Minor Health 2021; 22:1347-1367. [PMID: 32172498 DOI: 10.1007/s10903-020-00987-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this systematic review is to provide physicians and researchers with a comprehensive list of reported genetic disorders in patients of Syrian origin-those who have become part of the largest displaced population globally-and to highlight the need to consider migrant population-based risk for the development of genetic disease control and prevention programs. This review was performed based on the 2015 PRISMA and the international prospective register of systematic reviews. The present review reports on a total of 166 genetic disorders (only 128 reported on OMIM) identified in the Syrian population. Of these disorders, 27% are endocrine-, nutritional- and metabolic-related diseases. Second to metabolic disorders are congenital malformations, deformations and chromosomal abnormalities. Diseases of the blood and the blood-forming organs accounted for 13% of the total genetic disorders. The majority of the genetic disorders reported in Syrian patients followed an autosomal recessive mode of inheritance. These findings are a reflection of the high rates of consanguineous marriages that favor the increase in incidence of these diseases. From the diseases that followed an autosomal recessive mode of inheritance, 22% are reported to be only present in Syria and other regional countries. Twelve of these genetic diseases were identified to be strictly diagnosed in individuals of Syrian origin. The present systematic review highlights the need to develop programs that target genetic disorders affecting Syrian migrants in host countries. These programs would have potential financial and economic benefits, as well as a positive impact on the physical and mental health of members of the Syrian refugee community and those of their host societies. In turn, this would decrease the burden on the health systems in host countries.
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Affiliation(s)
- Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Office of Faculty Affairs, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirna Bou Hamdan
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ghunwa Nakouzi
- Department of Clinical Pathology, Cleveland Clinic Hospital, Cleveland, OH, USA.
| | - Soha Yazbek
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon.
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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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Evaluation of non-endemic pemphigus foliaceus in a large series of patients: a single-center retrospective study from Turkey focuses on the relapses. An Bras Dermatol 2021; 96:422-428. [PMID: 34059391 PMCID: PMC8245731 DOI: 10.1016/j.abd.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pemphigus foliaceus is exceedingly rare around the world, except within the few regions where it occurs as an endemic variant. Various factors can trigger immune mechanisms that induce pemphigus foliaceus or worsen its course. OBJECTIVE To determine the demographic and clinical characteristics of the patients with pemphigus foliaceus in a large series from a non-endemic country, investigate the triggering factors, and seasonal patterns. METHODS The data of the patients diagnosed with pemphigus foliaceus in the study's center between 1989-2018 were retrospectively analyzed. RESULTS Sixty-eight patients (mean age, 45.7 ± 14.5 years) were included in the study. The number of onsets reached its peak in spring-summer (p = 0.008). A total of 117 relapses occurred in 42 patients and were most common in spring-summer (not significant). Specific trigger factors were detected in 45 relapses. In the other 72 relapses, the peak was observed in spring-summer (p = 0.005). There were no significant differences in the demographic and clinical variables investigated between relapsed and non-relapsed patients. STUDY LIMITATIONS Retrospective design. CONCLUSIONS Triggering factors could not be identified in more than half of the relapses in the study's series. The subgroup of relapses (without identified causes), as well as the onsets of the disease, showed a significant seasonal variation with a peak in spring-summer; however, the seasonal variable did not justify the total group of relapses. Although the seasonal variation may be caused by a combination of factors, UV radiation should be considered a trigger factor for the peaks in spring-summer, particularly in Turkey.
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Brar A, Sharma A, Nauhria S, Nauhria S, Bhattacharjee A, Peela J, Joshi K. Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders. Cureus 2021; 13:e14562. [PMID: 34026378 PMCID: PMC8133519 DOI: 10.7759/cureus.14562] [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] [Indexed: 11/05/2022] Open
Abstract
Background Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. Aims The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. Methods The present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014-2017). Histopathological examination and DIF were conducted on all samples. Results Pemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. Conclusion DIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings.
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Affiliation(s)
- Arika Brar
- Department of Pathology, Swai Man Singh Medical College and Hospital, Jaipur, IND
| | - Abhimanyu Sharma
- Department of Pathology, Maharishi Markandeshwar University, Ambala, IND
| | - Samal Nauhria
- Department of Pathology, St. Matthew's University, Georgetown, CYM
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester, GBR
| | | | - Jagannadha Peela
- Department of Biochemistry and Genetics, St. Matthew's University, Georgetown, CYM
| | - Kusum Joshi
- Department of Pathology, Maharishi Markandeshwar University, Ambala, IND
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19
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Subepithelial autoimmune blistering dermatoses: Clinical features and diagnosis. J Am Acad Dermatol 2021; 85:1-14. [PMID: 33684496 DOI: 10.1016/j.jaad.2020.11.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Abstract
Subepithelial autoimmune blistering dermatoses are a group of rare skin disorders that are characterized by the disruption of the dermal-epidermal junction through the action of autoantibodies. The third article in this continuing medical education series explores the background, epidemiology, clinical features, and diagnostic criteria of each of the major subepithelial autoimmune blistering dermatoses, including bullous pemphigoid, pemphigoid gestationis, lichen planus pemphigoides, mucous membrane pemphigoid, linear IgA bullous dermatosis, and dermatitis herpetiformis.
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20
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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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21
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KUTLUBAY Z, SEVİM KEÇİCİ A, ÇELİK U, MAT C. A survey of bullous diseases in a Turkish university hospital: clinicoepidemiological characteristics and follow-up. Turk J Med Sci 2021; 51:124-133. [PMID: 32892539 PMCID: PMC7991873 DOI: 10.3906/sag-2006-231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Autoimmune bullous diseases, if left untreated, are life-threatening conditions affecting primarily skin and mucous membranes. These blistering disorders are characterized by epidermal or subepidermal detachment. Autoimmunity plays a key role in pathogenesis; therefore, immunosuppressive agents are the treatment of choice. The aim of this study is to document relative frequencies of different autoimmune bullous diseases, patient characteristics, treatment options, and side effects in patients presenting to our bullous skin disease center at İstanbul University, Cerrahpaşa, Cerrahpaşa Medical Faculty. Materials and methods Medical files were examined retrospectively for all patients with autoimmune bullous diseases who were followed up between 2003 and 2019 at the Bullous Skin Disease Center at İstanbul University, Cerrahpaşa. Results A total of 346 patient files were examined. Pemphigus vulgaris was the most frequent autoimmune bullous disease, followed by bullous pemphigoid and pemphigus foliaceus, according to our study. There is a general female predominancy for all autoimmune bullous diseases. The most commonly preferred treatment options were high-dose daily corticosteroids. Conclusion This retrospective study summarizes the patient characteristics, comorbidities, treatment choices, and side effects during 16 years of clinical practice.
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Affiliation(s)
- Zekayi KUTLUBAY
- Department of Dermatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbulTurkey
| | - Ayşegül SEVİM KEÇİCİ
- Department of Dermatology, University of Medical Sciences, Haydarpaşa Numune Training and Research Hospital, İstanbulTurkey
| | - Uğur ÇELİK
- Department of Dermatology, Medipol University, İstanbulTurkey
| | - Cem MAT
- Department of Dermatology, Private Practice, İstanbulTurkey
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22
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van Beek N, Weidinger A, Schneider SW, Kleinheinz A, Gläser R, Holtsche MM, von Georg A, Hammers CM, Hübner F, Lima AL, Gola D, Sadik CD, Zillikens D, Katalinic A, Schmidt E, König IR. Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases. J Eur Acad Dermatol Venereol 2021; 35:1197-1202. [PMID: 33428263 DOI: 10.1111/jdv.17107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. OBJECTIVES To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). METHODS Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. RESULTS Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. CONCLUSIONS This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.
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Affiliation(s)
- N van Beek
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A Weidinger
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S W Schneider
- Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbe Medical Center, Buxtehude, Germany
| | - R Gläser
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M M Holtsche
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A von Georg
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - C M Hammers
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - F Hübner
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A-L Lima
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - D Gola
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - C D Sadik
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A Katalinic
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
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23
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A retrospective analysis of pemphigus vulgaris patients: Demographics, diagnosis, co-morbid diseases and treatment modalities used. North Clin Istanb 2021; 7:597-602. [PMID: 33381700 PMCID: PMC7754874 DOI: 10.14744/nci.2020.37039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/29/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Pemphigus vulgaris is an autoimmune blistering disease affecting the mucosal surfaces as well as the skin. Twenty-eight retrospective studies about the epidemiologic data of pemphigus vulgaris patients have been performed previously in the literature. METHODS In this retrospective study, we evaluated 320 pemphigus vulgaris patients who applied to the bullous diseases clinic of Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Dermatology, between the years 1999-2019. Epidemiologic data, diagnostic modalities, comorbidities and treatment modalities were noted. RESULTS The female to male ratio was 1.39. The mean age of diagnosis was 50.4±13.7 years, 50.8±12.5 years for males and 50.0±14.5 years for females. The average disease duration was 99.0±74.4 months; it was 91.6±67.2 months for males and 104.5±79.0 months for females. At the time of diagnosis, 88.7% of our patients had mucosal lesions and 68.4% of our patients had cutaneous lesions. The most common side effects were hypertension, diabetes mellitus, osteoporosis and hyperlipidemia. Adjuvant therapy was initiated 332 times. Azathioprine was used in 260 patients,Mycophenolate sodium was used in 30 patients, Mycophenolate mofetil was used in 42 patients, IVIG was used in 52 patients, Rituximab was used in 51 patients. CONCLUSION Pemphigus vulgaris is a disease that is more commonly seen in female patients. It has a peak incidence in the fifth decade and there is not a statistically significant difference between the age of diagnosis between the genders. It is a chronic disease with a long follow-up period; again, there no statistically significant difference between the two genders. The most commonly encountered comorbidities are hypertension, hyperlipidemia, diabetes mellitus and osteoporosis, which are due to the use of corticosteroids.
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24
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Pemphigus Vulgaris: A Clinical Study of 31 Cases (2004-2014) in Morocco. Dermatol Res Pract 2020; 2020:8535109. [PMID: 32963520 PMCID: PMC7495221 DOI: 10.1155/2020/8535109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/09/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Pemphigus vulgaris is a rare bullous autoimmune dermatosis whose evolution and prognosis are unpredictable. Aim The objective was to analyze long-term outcomes in patients with pemphigus vulgaris by identifying the factors that are able to influence prognosis, in particular the phenotype of pemphigus vulgaris, age at onset, multiplicity of mucosal involvement, relapse and remission rates, and survival functions. Methods A retrospective analysis of a cohort of 31 patients followed for pemphigus vulgaris during the period from January 2004 to January 2014. Inclusion criteria were a diagnosis of pemphigus vulgaris confirmed by histopathology and direct immunofluorescence (DIF) and a period of follow-up of at least five years from the diagnosis. The following information was collected by a single investigator. Results In total, 67.7% of patients presented a mucocutaneous pemphigus vulgaris. Male-female sex ratio was 2.4. The median duration of patient's follow-up was estimated at 7 (6–9) years. Multiple mucosal involvement in the oral cavity and at other mucosal sites was significantly associated with severe mucocutaneous pemphigus vulgaris (p=0.01). Multiple relapses were significantly associated with the disease severity (p=0.04). Conclusion Poor prognosis factors were severe mucocutaneous type of pemphigus vulgaris and multiple mucosal involvement in the oral cavity and at other mucosal sites.
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25
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Liu SD, Chen WT, Chi CC. Association Between Medication Use and Bullous Pemphigoid: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:891-900. [PMID: 32584924 PMCID: PMC7301306 DOI: 10.1001/jamadermatol.2020.1587] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
Importance The association between the use of medications and the development of bullous pemphigoid (BP) is unclear. Objective To assess the associations between previous exposure to certain medications and BP. Data Sources For this systematic review and meta-analysis, PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched for relevant studies from inception to February 20, 2020. Study Selection Case-control or cohort studies and randomized clinical trials that examined the odds or risk of BP in patients with previous medication use were included. No geographic or language limitations were imposed. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline was followed. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of included observational studies; Cochrane Collaboration's tool was used for randomized clinical trials. Aggregate data were used to conduct a random-effects model meta-analysis if the included studies were sufficiently homogenous. Subgroup analyses were performed for use of various medications of the same category. Main Outcomes and Measures Odds ratio (OR), hazard ratio, and risk ratio of bullous pemphigoid in association with medication use. Results This meta-analysis included 13 case-control studies, 1 cohort study, and 1 randomized clinical trial with a total of 285 884 participants. The meta-analysis of case-control studies showed a significant association of BP with previous use of aldosterone antagonists (pooled OR, 1.75; 95% CI, 1.28-2.40), dipeptidyl peptidase 4 inhibitors (pooled OR, 1.92; 95% CI, 1.55-2.38), anticholinergics (pooled OR, 3.12; 95% CI, 1.54-6.33), and dopaminergic medications (pooled OR, 2.03; 95% CI, 1.34-3.05). One cohort study found an increased risk of BP among patients receiving dipeptidyl peptidase 4 inhibitors (hazard ratio, 2.38; 95% CI, 1.16-4.88; P = .02). One trial found a higher occurrence of BP in patients with diabetes receiving linagliptin (0.2% in diabetes group vs 0% in the placebo group). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that aldosterone antagonists, dipeptidyl peptidase 4 inhibitors, anticholinergics, and dopaminergic medications are associated with BP. These medications should be judiciously prescribed, particularly in high-risk patients who are elderly and have disabling neurologic disorders.
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Affiliation(s)
- Sian-De Liu
- Department of Pharmacy, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - Wei-Ti Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Xiamen Chang Gung Memorial Hospital, Fujian, China
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Xiamen Chang Gung Memorial Hospital, Fujian, China
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26
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Calabria E, Fortuna G, Aria M, Mignogna MD. Autoimmune mucocutaneous blistering diseases in the south of Italy: a 25-year retrospective study on 169 patients. J Oral Pathol Med 2020; 49:672-680. [PMID: 32531813 DOI: 10.1111/jop.13059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autoimmune mucocutaneous blistering diseases (AMBDs) represent a heterogeneous group of organ-specific and potentially life-threatening diseases. We sought to determine the relationship between clinical remission and therapeutic regimens with clinical type and phenotype of AMBDs, as well as clinical outcomes achieved based on different therapeutic regimens. METHODS A retrospective single-center study on 169 AMBDs patients, including pemphigus vulgaris (PV), mucous membrane pemphigoid (MMP), paraneoplastic autoimmune multiorgan syndrome (PAMS), and lichen planus pemphigoides (LPP), was performed from 1994 to 2019 in an oral medicine tertiary center, where we collected sociodemographic data, clinical type and phenotype, prescribed therapies, and related outcomes. RESULTS The mean age of AMBDs patients was 55.0 ± 16.4 years. They were followed for a mean of 8.4 ± 5.8 years. The majority of these patients (62.1%) were successfully managed with conventional immunosuppressive therapy (CIST) alone. However, 37.9% of patients required additional biological treatments, either because they were non-responders or developed severe side effects from CIST, or because of the rapid and severe progression of the disease. Overall, complete clinical remission was achieved in 92.3% of patients. A statistically significant difference was noted between the frequency distribution of AMBDs patients among different therapeutic regimens (P = .002), of different clinical phenotype and type of AMBDs patients and clinical remission (P = .012 and P = .005, respectively). No difference was reported regarding clinical outcomes and different therapeutic regimens. CONCLUSIONS AMBDs' management may be challenging, nonetheless CIST and biologic regimens introduced, when needed as reliable alternatives to CIST, result in a very high percentage of CCR.
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Affiliation(s)
- Elena Calabria
- Department of Neurosciences, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy.,UCL Eastman Dental Institute, London, UK
| | - Giulio Fortuna
- Glasgow Dental School & Hospital, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,D.eb.RA. Mexico Foundation, Nuevo Leon, Mexico.,Federico Navarro Institute-School of Orgonomy "Piero Borrelli", Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, Federico II University of Naples, Naples, Italy
| | - Michele D Mignogna
- Department of Neurosciences, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
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27
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Persson MSM, Harman KE, Vinogradova Y, Langan SM, Hippisley-Cox J, Thomas KS, Gran S. Incidence, prevalence and mortality of bullous pemphigoid in England 1998-2017: a population-based cohort study. Br J Dermatol 2020; 184:68-77. [PMID: 32147814 DOI: 10.1111/bjd.19022] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND A rising incidence and high mortality were found for bullous pemphigoid (BP) over a decade ago in the UK. Updated estimates of its epidemiology are required to understand the healthcare needs of an ageing population. OBJECTIVES To determine the incidence, prevalence and mortality rates of BP in England from 1998 to 2017. METHODS We conducted a cohort study of longitudinal electronic health records using the Clinical Practice Research Datalink and linked Hospital Episode Statistics. Incidence was calculated per 100 000 person-years and annual point prevalence per 100 000 people. Multivariate analysis was used to determine incidence rate ratios by sociodemographic factors. Mortality was examined in an age-, sex- and practice-matched cohort, using linked Office of National Statistics death records. Hazard ratios (HRs) were stratified by matched set. RESULTS The incidence was 7·63 [95% confidence interval (CI) 7·35-7·93] per 100 000 person-years and rose with increasing age, particularly for elderly men. The annual increase in incidence was 0·9% (95% CI 0·2-1·7). The prevalence almost doubled over the observation period, reaching 47·99 (95% CI 43·09-53·46) per 100 000 people and 141·24 (95% CI 125·55-158·87) per 100 000 people over the age of 60 years. The risk of all-cause mortality was highest in the 2 years after diagnosis (HR 2·96; 95% CI 2·68-3·26) and remained raised thereafter (HR 1·54; 95% CI 1·36-1·74). CONCLUSIONS We report a modest increase in the incidence rate of BP, but show that the burden of disease in the elderly population is considerable. Mortality is high, particularly in the first 2 years after diagnosis.
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Affiliation(s)
- M S M Persson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - K E Harman
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Y Vinogradova
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - S M Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - J Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S Gran
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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28
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Autoimmune bullous skin diseases, pemphigus and pemphigoid. J Allergy Clin Immunol 2020; 145:1031-1047. [DOI: 10.1016/j.jaci.2020.02.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
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29
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Hübner F, Langan EA, Recke A. Lichen Planus Pemphigoides: From Lichenoid Inflammation to Autoantibody-Mediated Blistering. Front Immunol 2019; 10:1389. [PMID: 31312198 PMCID: PMC6614382 DOI: 10.3389/fimmu.2019.01389] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
Lichen planus pemphigoides (LPP) is a very rare autoimmune sub-epidermal blistering disease associated with lichenoid skin changes. Initially thought to be a mere variant of more common inflammatory dermatoses, particularly Bullous Pemphigoid (BP) or Lichen Planus (LP), a growing body of evidence suggests that it is a disease entity in its own right. In common with a range of autoimmune blistering diseases, including BP, pemphigoid gestationis (PG), mucous membrane pemphigoid (MMP) and linear IgA dermatosis (LAD), a key feature of the disease is the development of autoantibodies against type XVII collagen (COL17). However, accurately establishing the diagnosis is dependent on a careful correlation between the clinical, histological and immunological features of the disease. Therefore, we present an up to date summary of the epidemiology and etiopathogenesis of LPP, before illustrating the predisposing and precipitating factors implicated in the development of the disease. In addition to a selective literature search, we compare reports of potential drug-induced cases of LPP with pharmacovigilance data available via OpenVigil. We subsequently outline the cardinal clinical features, important differential diagnoses and current treatment options. We conclude by demonstrating that an improved understanding of LPP may not only lead to the development of novel treatment strategies for the disease itself, but may also shed new light on the pathophysiology of more common and treatment-refractory autoimmune blistering diseases.
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Affiliation(s)
- Franziska Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ewan A. Langan
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Dermatological Research, University of Lübeck, Lübeck, Germany
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30
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Abstract
Bullous pemphigoid is the most frequent autoimmune bullous disease and mainly affects elderly individuals. Increase in incidence rates in the past decades has been attributed to population aging, drug-induced cases and improvement in the diagnosis of the nonbullous presentations of the disease. A dysregulated T cell immune response and synthesis of IgG and IgE autoantibodies against hemidesmosomal proteins (BP180 and BP230) lead to neutrophil chemotaxis and degradation of the basement membrane zone. Bullous pemphigoid classically manifests with tense blisters over urticarial plaques on the trunk and extremities accompanied by intense pruritus. Mucosal involvement is rarely reported. Diagnosis relies on (1) the histopathological evaluation demonstrating eosinophilic spongiosis or a subepidermal detachment with eosinophils; (2) the detection of IgG and/or C3 deposition at the basement membrane zone using direct or indirect immunofluorescence assays; and (3) quantification of circulating autoantibodies against BP180 and/or BP230 using ELISA. Bullous pemphigoid is often associated with multiple comorbidities in elderly individuals, especially neurological disorders and increased thrombotic risk, reaching a 1-year mortality rate of 23%. Treatment has to be tailored according to the patient's clinical conditions and disease severity. High potency topical steroids and systemic steroids are the current mainstay of therapy. Recent randomized controlled studies have demonstrated the benefit and safety of adjuvant treatment with doxycycline, dapsone and immunosuppressants aiming a reduction in the cumulative steroid dose and mortality.
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Affiliation(s)
- Denise Miyamoto
- Division of Dermatology, Hospital das Clínicas,
Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP),
Brazil
| | - Claudia Giuli Santi
- Division of Dermatology, Hospital das Clínicas,
Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP),
Brazil
| | - Valéria Aoki
- Department of Dermatology, Faculdade de Medicina,
Universidade de São Paulo, São Paulo (SP), Brazil
| | - Celina Wakisaka Maruta
- Department of Dermatology, Faculdade de Medicina,
Universidade de São Paulo, São Paulo (SP), Brazil
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31
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Abstract
Pemphigus forms a group of rare autoimmune bullous diseases that affect the skin and mucous membranes. This group has a chronic course leading to high morbidity and mortality. It is characterized by the production of pathogenic autoantibodies directed against different proteins of the desmosome, leading histologically to intraepidermal cleavage, and clinically to vesicles and erosions on the epithelium of the mucous membranes and/or the skin. The diagnosis of the subtype of pemphigus is based on clinical features, the level of histologic cleavage, and the identification of the antigens recognized by circulating autoantibodies by immunoserological analyses. The epidemiological features of pemphigus vary considerably in different regions of the world. Observational studies examining comorbidities and associations among patients with pemphigus are scarce and sometimes inconclusive. The prognosis, mortality, and clinical outcomes in pemphigus have undergone dramatic change throughout the years. This review provides a brief overview about the different subtypes of pemphigus: pemphigus vulgaris, pemphigus foliaceus, paraneoplastic pemphigus, pemphigus herpetiformis, and IgA pemphigus. In addition, it summarizes the most recent understanding of the epidemiology, mortality data, and comorbidities of this group of organ-specific autoimmune diseases.
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Abstract
Subepidermal autoimmune bullous diseases of the skin and mucosae comprise a large group of chronic diseases, including bullous pemphigoid, pemphigoid gestationis, mucous membrane pemphigoid, linear IgA bullous dermatosis, epidermolysis bullosa acquisita, and anti-p200 pemphigoid. These diseases are characterized by an antibody response toward structural components of the basement membrane zone, resulting in subepidermal blistering. The epidemiological features of these diseases vary substantially in different regions of the world. Observational studies investigating comorbidities and associations among patients with these diseases are inconsistent and sometimes inconclusive. This review provides a brief overview regarding each one of the subepidermal autoimmune bullous diseases. In addition, it summarizes the most recent understanding of the epidemiological features and associations of this group of organ-specific autoimmune diseases.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, POB 9602, 31096, Haifa, Israel.
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Koga H, Prost-Squarcioni C, Iwata H, Jonkman MF, Ludwig RJ, Bieber K. Epidermolysis Bullosa Acquisita: The 2019 Update. Front Med (Lausanne) 2019; 5:362. [PMID: 30687710 PMCID: PMC6335340 DOI: 10.3389/fmed.2018.00362] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is an orphan autoimmune disease. Patients with EBA suffer from chronic inflammation as well as blistering and scarring of the skin and mucous membranes. Current treatment options rely on non-specific immunosuppression, which in many cases, does not lead to a remission of treatment. Hence, novel treatment options are urgently needed for the care of EBA patients. During the past decade, decisive clinical observations, and frequent use of pre-clinical model systems have tremendously increased our understanding of EBA pathogenesis. Herein, we review all of the aspects of EBA, starting with a detailed description of epidemiology, clinical presentation, diagnosis, and current treatment options. Of note, pattern analysis via direct immunofluorescence microscopy of a perilesional skin lesion and novel serological test systems have significantly facilitated diagnosis of the disease. Next, a state-of the art review of the current understanding of EBA pathogenesis, emerging treatments and future perspectives is provided. Based on pre-clinical model systems, cytokines and kinases are among the most promising therapeutic targets, whereas high doses of IgG (IVIG) and the anti-CD20 antibody rituximab are among the most promising "established" EBA therapeutics. We also aim to raise awareness of EBA, as well as initiate basic and clinical research in this field, to further improve the already improved but still unsatisfactory conditions for those diagnosed with this condition.
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Affiliation(s)
- Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Catherine Prost-Squarcioni
- Department of Dermatology, APHP, Avicenne Hospital, Referral Center for Autoimmune Bullous Diseases, Bobigny, France
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Marcel F Jonkman
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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Evaluation of Comorbidities in Patients with Autoimmune Bullous Diseases: A Retrospective Study. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:302-306. [PMID: 32774095 PMCID: PMC7406551 DOI: 10.14744/semb.2018.55376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/08/2018] [Indexed: 12/30/2022]
Abstract
Objectives The purpose of the present study was to define the accompanying diseases of patients with autoimmune bullous diseases (ABDs). Methods One hundred forty-two patients with ABD who were followed up in the dermatology and venereology inpatient clinic of Şişli Hamidiye Etfal Training and Research Hospital between January 1999 and December 2015 were enrolled in the study. Age, gender, and accompanying diseases of the participants were recorded and compared with the healthy subjects. Results Eighty patients with pemphigus, 62 patients with pemphigoid, and 217 healthy subjects were included in the study. The pemphigoid group had a statistically significant higher prevalence of hypertension, diabetes mellitus, coronary artery diseases, cataract, malignancy, dementia, Alzheimer's disease, Parkinson's disease, and cerebrovascular events relative to the pemphigus and control groups (p<0.01, p<0.01, p=0.001, p<0.01, p=0.02, p=0.008, p=0.001, p=0.001, and p<0.01, respectively). The prevalence of asthma, benign prostatic hyperplasia, and cataract was higher in the pemphigus group than in the controls (p=0.02, p=0.04, and p=0.02, respectively). Conclusion To the best of our knowledge, this is the first study comparing accompanying diseases between controls and patients with pemphigus and pemphigoid. It is disputable whether the diseases mentioned occur due to some common pathophysiological pathways or coexist just coincidentally. We believe that it is important to evaluate accompanying diseases in patients with ABD.
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Kridin K, Ludwig RJ. The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations. Front Med (Lausanne) 2018; 5:220. [PMID: 30177969 PMCID: PMC6109638 DOI: 10.3389/fmed.2018.00220] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/17/2018] [Indexed: 12/25/2022] Open
Abstract
Bullous pemphigoid (BP) is the most common type of subepidermal autoimmune bullous diseases. BP characteristically affects the elderly and is seen mainly in patients older than 70 years. While the annual incidence of BP has been estimated to be between 2.4 and 23 cases per million in the general population, it rises exponentially to 190-312 cases per million in individuals older than 80 years. In addition, a growing body of evidence reports a remarkable trend of increased incidence of BP, showing a 1.9- to 4.3-fold rise over the past two decades. This demonstrable increase warrants a higher awareness of the increased risk to develop BP. This review summarizes the current understanding of the epidemiological features of BP and sheds light on the putative explanations for its growing incidence.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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Milinković MV, Janković S, Medenica L, Nikolić M, Reljić V, Popadić S, Janković J. Incidence of autoimmune bullous diseases in Serbia: a 20-year retrospective study. J Dtsch Dermatol Ges 2018; 14:995-1005. [PMID: 27767273 DOI: 10.1111/ddg.13081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES While most previous surveys on the clinico-epidemiological features of autoimmune bullous diseases (AIBDs) have predominantly focused on a single disease entity or just one disease group, there have been only few studies examining the incidence of various AIBDs. In the present study, we set out to determine the spectrum of AIBDs, to estimate the incidence of the most common AIBDs, and to examine their temporal trends in Central Serbia over a period of 20 years. METHODS We retrospectively recruited 1,161 new AIBD cases diagnosed in Central Serbia during the period from January 1991 to December 2010. The diagnosis was based on strict clinical, histological, and immunohistological evaluation. RESULTS The incidence rates were: 4.35 per million population/year (pmp/year) for pemphigus, 4.47 pmp/year for pemphigoid, 1.42 pmp/year for dermatitis herpetiformis (DH), 0.25 pmp/year for linear IgA disease, and 0.08 pmp/year for epidermolysis bullosa acquisita. In the period observed, age-adjusted incidence rates significantly increased for pemphigus and particularly for pemphigoid, whereas they decreased, albeit not significantly, for DH. CONCLUSIONS For the first time, our study evaluates the incidence rates of the entire spectrum of AIBDs in Serbia, and examines their temporal trends over a 20-year period. To the best of our knowledge, our finding of similar incidence rates for pemphigus and pemphigoid has previously not been reported.
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Affiliation(s)
- Mirjana V Milinković
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia. .,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Medenica
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Reljić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Popadić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Li S, Zhang Q, Wang P, Li J, Ni J, Wu J, Liang Y, Leng RX, Pan HF, Ye DQ. Association between HLA-DQB1 polymorphisms and pemphigus vulgaris: A meta-analysis. Immunol Invest 2017; 47:101-112. [PMID: 29182409 DOI: 10.1080/08820139.2017.1385622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was performed to systematically summarize the results on the association of HLA-DQB1 polymorphisms with pemphigus vulgaris (PV) and other related factors. METHODS A comprehensive literature search of PubMed, The Cochrane Library, Embase, and Google Scholar database was conducted to identify relevant articles in English, with the last report up to November 1, 2016. Heterogeneity test was performed, and publication bias was evaluated. Stata software 12.0 was used to perform the meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CI) were used to describe the correlation by random-effects model. RESULTS 18 studies were obtained after searching databases: 10 studies were about Caucasian, and 8 articles were about non-Caucasian. Meta-analysis revealed that the allele and phenotype frequencies of DQB1*05 were markedly higher in PV patients than in controls [P < 0.001, OR: 2.640, 95%CI: 1.570-4.441; P = 0.030, OR 3.688, 95%CI: 1.138-11.946]. In addition, DQB1*03 was significantly increased at the allele level [P < 0.001, OR: 2.080, 95%CI: 1.507-2.869], and DQB1*02 was significantly decreased in PV at the allele and phenotype levels [P = 0.002, OR: 0.450, 95%CI: 0.289-0.702; P = 0.001, OR: 0.293, 95%CI: 0.146-0.587]. When based on each subtype of HLA-DQB1, DQB1*05:03 and DQB1*03:02 may play susceptibility roles in PV, and DQB1*03:03, DQB1*05:01 and DQB1*06:01 are negatively associated with PV. CONCLUSION In summary, our study suggests that alleles from the groups DQB1*05 and DQB1*03, concretely DQB1*05:03 and DQB1*03:02, respectively, may be the susceptibility factors for PV at allele and phenotype levels, whereas DQB1*05:01, DQB1*02, DQB1*06:01, and DQB1*03:03 are negatively associated with PV.
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Affiliation(s)
- Si Li
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Qin Zhang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Peng Wang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jun Li
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jing Ni
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jun Wu
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Yan Liang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Rui-Xue Leng
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Hai-Feng Pan
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Dong-Qing Ye
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
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Abstract
Many skin diseases can occur in pregnant women. However, a few pruritic dermatological conditions are unique to pregnancy, including pemphigoid gestationis (PG). As PG is associated with severe morbidity for pregnant women and carries fetal risks, it is important for the clinician to quickly recognize this disease and refer it for dermatological evaluation and treatment. Herein, we review the pathogenesis, clinical characteristics, and management of PG.
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Affiliation(s)
| | - Freja Lærke Sand
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kridin K, Bergman R. Ethnic variations in the epidemiology of bullous pemphigoid in Israel. Int J Dermatol 2017; 57:34-39. [PMID: 29090462 DOI: 10.1111/ijd.13813] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/06/2017] [Accepted: 09/21/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND No ethnic or geographic predisposition to bullous pemphigoid (BP) was reported so far. OBJECTIVE To evaluate trends in the incidence of BP in northern Israel, shedding light on differences between two distinct ethnic populations who inhabit the same region, namely Jews and Arabs. METHODS Bullous pemphigoid incidence was retrospectively estimated from January 2000-December 2015 in two Israeli regions with a total population of 1.56 million inhabitants. RESULTS A total of 287 new-onset BP patients (mean age: 77.6 ± 12.1) were identified. The incidence rate was 11.4 per million inhabitants per year (95% CI, 10.2-12.9). The crude incidence rate in Jews was 4.8-fold higher than that in Arabs (16.4 vs. 3.4 cases per million per year, respectively [P < 0.0001]). After adjusting for age, the discrepancy between the two populations diminished (11.7 vs. 8.9 cases per million per year, respectively) but remained statistically significant (P = 0.032). The incidence increased consistently from 7.6 cases per million per year in the calendar period 2000-2005 to 12.6 and 14.3 cases in 2006-2010 and 2011-2015, respectively (P < 0.0001). Bullous pemphigoid patients of Arab ancestry presented with the disease significantly earlier than Jews (69.5 ± 15.3 vs. 78.7 ± 11.1 years, respectively, P = 0.002). CONCLUSIONS The incidence of BP in northern Israel has increased in the last 16 years and is significantly higher among Jews compared to Arabs. The age of presentation is remarkably different between patients belonging to the two populations.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
Autoimmune blistering diseases (AIBD) are a group of chronic diseases affecting the skin and mucous membranes, with different presentation, clinical course, histologic and immunopathologic findings, and different therapeutic approach. Blisters develop as a result of autoantibodies directed against distinct adhesion structures within desmosomes or within the basement membrane zone. The most common AIBD that develops in the elderly is bullous pemphigoid (previously also named "pemphigoid senilis"), but mature patients can also present with other AIBD as mucous membrane pemphigoid, epidermolysis bullosa acquisita, paraneoplastic pemphigus, pemphigus vulgaris, pemphigus foliaceus, linear IgA dermatosis, and dermatitis herpetiformis. There are no differences in treatment approach to mature patients with AIBD, but due to more common comorbidities, systemic therapy should be given with more caution and control, and due to distorted skin integrity in the aged skin, the safety concerns are increased with the long-term use of any topical medication.
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Affiliation(s)
- Ines Lakoš Jukić
- Department of Dermatovenereology, University Hospital Center Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Sandra Jerković Gulin
- Department of Infectious Diseases and Dermatovenereology, General Hospital Šibenik, Šibenik, Croatia
| | - Branka Marinović
- Department of Dermatovenereology, University Hospital Center Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia.
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Thorslund K, Seifert O, Nilzén K, Grönhagen C. Incidence of bullous pemphigoid in Sweden 2005-2012: a nationwide population-based cohort study of 3761 patients. Arch Dermatol Res 2017; 309:721-727. [PMID: 28875235 PMCID: PMC5648739 DOI: 10.1007/s00403-017-1778-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 01/27/2023]
Abstract
Studies that report the incidence of bullous pemphigoid from validated nationwide population-based registries are rare. The aim of this study was to estimate the incidence of bullous pemphigoid in Sweden 2005–2012. A population-based open cohort study was designed including all patients diagnosed by a dermatologist with bullous pemphigoid (BP) in Sweden from 2005 to 2012 (n = 3761), identified from the National Patient Register (NPR). The diagnosis of bullous pemphigoid in the NPR was recently validated from medical records, histopathological and immunopathological data by our group in a previous study. The average annual incidence of bullous pemphigoid was 7.1/100,000 (95% CI 6.5–7.7). Female to male ratio was 1.2:1, mean age at diagnosis was 78.9 years. The age-specific incidence rate increased markedly after 80 years of age with an incidence peak between 90 and 99 years of age, 81.9/100,000 (95% CI 75.0–89.2). This large nationwide cohort study presents an adjusted incidence of BP of 7.1/100,000 (95% CI 6.5–7.7) in Sweden. The incidence of bullous pemphigoid is higher than expected and bullous pemphigoid is a common disease in the elderly population.
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Affiliation(s)
- Kristofer Thorslund
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Oliver Seifert
- Division of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Karin Nilzén
- Division of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden
| | - Carina Grönhagen
- Department of Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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Milinković M, Janković S, Medenica L, Nikolić M, Reljić V, Popadić S, Janković J. Inzidenz von bullösen Autoimmunerkrankungen in Serbien: eine retrospektive Studie über 20 Jahre. J Dtsch Dermatol Ges 2016; 14:995-1006. [DOI: 10.1111/ddg.13081_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mirjana Milinković
- Klinik für Dermato-Venerologie; Klinisches Zentrum Serbien; Belgrad Serbien
- Abteilung Dermato-Venerologie; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
| | - Slavenka Janković
- Institut für Epidemiologie; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
| | - Ljiljana Medenica
- Klinik für Dermato-Venerologie; Klinisches Zentrum Serbien; Belgrad Serbien
- Abteilung Dermato-Venerologie; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
| | - Miloš Nikolić
- Klinik für Dermato-Venerologie; Klinisches Zentrum Serbien; Belgrad Serbien
- Abteilung Dermato-Venerologie; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
| | - Vesna Reljić
- Klinik für Dermato-Venerologie; Klinisches Zentrum Serbien; Belgrad Serbien
| | - Svetlana Popadić
- Klinik für Dermato-Venerologie; Klinisches Zentrum Serbien; Belgrad Serbien
- Abteilung Dermato-Venerologie; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
| | - Janko Janković
- Institut für Sozialmedizin; Medizinische Fakultät; Universität Belgrad; Belgrad Serbien
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Vorobyev A, Ludwig RJ, Schmidt E. Clinical features and diagnosis of epidermolysis bullosa acquisita. Expert Rev Clin Immunol 2016; 13:157-169. [PMID: 27580464 DOI: 10.1080/1744666x.2016.1221343] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disease of skin and mucous membranes. EBA is caused by autoantibodies against type VII collagen, which is a major component of anchoring fibrils, attaching epidermis to dermis. Binding of autoantibodies to type VII collagen leads to skin fragility and, finally, blister formation. The clinical picture of EBA is polymorphic, with several distinct phenotypes being described. Despite recent progress in understanding the pathophysiology of EBA, its diagnosis is still challenging. Areas covered: This review provides an update on the clinical manifestations and diagnostic methods of EBA. We searched PubMed using the terms 'epidermolysis bullosa acquisita' covering articles in English between 1 January 2005 and 31 May 2016. Relevant older publications were retrieved form cited literature. Expert commentary: While the clinical picture is highly variable, diagnosis relies on direct immunofluorescence (IF) microscopy of a perilesional skin biopsy. Linear deposits of IgG, IgA and/or C3 along the dermal-epidermal junction with an u-serrated pattern are diagnostic for EBA alike the detection of serum autoantibodies against type VII collagen. Several test systems for the serological diagnosis of EBA have recently become widely available. In some patients, sophisticated diagnostic approaches only available in specialized centers are required.
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Affiliation(s)
- Artem Vorobyev
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Ralf J Ludwig
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Enno Schmidt
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
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Kridin K, Zelber-Sagi S, Khamaisi M, Cohen AD, Bergman R. Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region. J Am Acad Dermatol 2016; 75:925-930. [PMID: 27614531 DOI: 10.1016/j.jaad.2016.06.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/13/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The epidemiology of pemphigus in different ethnic populations exposed to similar environments is unknown. Trends in the incidence of pemphigus based on an immunopathologically validated cohort have not been investigated. OBJECTIVES We sought to estimate the incidence of pemphigus in Israel and to investigate differences between the 2 major ethnic populations. METHODS Pemphigus incidence was retrospectively estimated from January 2000 to December 2015 in 2 Israeli regions with a total population of 1.56 million inhabitants. RESULTS One hundred eighty patients with pemphigus (mean age, 54.70 ± 16 years) were identified. The overall estimated incidence was 7.2 per million inhabitants per year (95% confidence interval, 6.2-8.3). The incidence in the Jewish population was threefold higher than that in Arabs (9.6 vs 3.2 cases per million per year, respectively; P < .0001) and higher among women than men (9 vs 5.3 cases per million per year, respectively; P < .0001). The incidence decreased from 8.4 cases per million per year in 2000 to 2005 to 7.0 and 6.0 (95% confidence interval, 4.5-7.9) in 2006 to 2010 and 2011 to 2015, respectively (P = .068). LIMITATIONS This study was limited by the retrospective design and the small population. CONCLUSIONS The incidence of pemphigus in Israel is among the highest reported worldwide and is significantly more frequent among Jews.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Mogher Khamaisi
- Institute of Endocrinology, Diabetes and Metabolism and Internal Medicine D, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Sobhan M, Farshchian M, Tamimi M. Spectrum of autoimmune vesiculobullous diseases in Iran: a 13-year retrospective study. Clin Cosmet Investig Dermatol 2016; 9:15-20. [PMID: 26811692 PMCID: PMC4714738 DOI: 10.2147/ccid.s97214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Autoimmune bullous diseases (ABDs) represent a group of rare, acquired disorders characterized by overlapping features with involvement of the skin and mucous membranes, resistance to treatment, and potential lethality that comprise pemphigus, bullous pemphigoid (BP), epidermolysis bullosa, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis. AIM The main aim of this study was to identify the epidemiologic characteristics and clinical courses of these common diseases in Hamadan, Iran. Few surveys have been carried out to demonstrate the whole spectrum of ABDs in the literature. Notably, in Hamadan we are the first. MATERIALS AND METHODS This 13-year retrospective study was designed to evaluate all of documented data obtained from hospitalized patients with ABDs at Farshchian Hospital from October 1999 to October 2012. We collected information on epidemiologic data, clinical aspects, histologic findings, and therapy prescribed. Data were analyzed using SPSS. RESULTS Of 168 patients, 78% had pemphigus. The age of patients at presentation ranged from 1 month to 115 years, with a mean of 47.5±19.93 years. Mucosal or skin involvement of ABDs was statistically significant (P<0.001). The incidence of ABDs differed significantly based on anatomic location (P=0.003). We documented three deaths. CONCLUSION Compared to previous literature, our findings showed equal epidemiologic properties in Iran. Although pemphigus was the most common ABD followed by BP, it is expected that in line with the global trend, an increase in BP will be driven by population aging in Iran.
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Affiliation(s)
- Mohammadreza Sobhan
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahmood Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Tamimi
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Autoimmune blistering diseases in females: a review. Int J Womens Dermatol 2015; 1:4-12. [PMID: 28491949 PMCID: PMC5418673 DOI: 10.1016/j.ijwd.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/23/2014] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
The autoimmune blistering diseases (AIBDs) are a group of heterogeneous skin diseases with autoantibodies directed against structural proteins in the skin. A new interest in the female bias towards autoimmune diseases in general has led to our attention to focus on how and why this female bias manifests in AIBD. The authors aim to review and explore the various aspects of AIBD affecting females more than males, including the higher prevalence, worse quality of life, and complex management issues such as pregnancy and lactation. What is already known on this topic? Echoing autoimmune diseases in general, most autoimmune blistering diseases (AIBDs) have a female predominance, but the exact level of predominance is unknown. Pregnancy raises several complicated management issues for females with an AIBD.
What does this article add to our knowledge? Review of sex-specific epidemiology and etiology of each AIBD. Exploration and explanation of the key factors underlying the detrimental impacts of AIBD on women’s quality of life (QOL). Discussion of management issues in pregnancy and lactation for females with an AIBD.
How does this information impact clinical practice and/or change patient care? An awareness and understanding of the female predominance in AIBDs will ensure more appropriate diagnosis, evaluation, and future research. Emphasizing holistic care targeting the debilitating effects of AIBDs on women’s QOL. Informing the reader of optimal, yet safe interventions for pregnant women with an AIBD.
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Alpsoy E, Akman-Karakas A, Uzun S. Geographic variations in epidemiology of two autoimmune bullous diseases: pemphigus and bullous pemphigoid. Arch Dermatol Res 2015; 307:291-8. [PMID: 25589418 DOI: 10.1007/s00403-014-1531-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/11/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
Autoimmune bullous diseases are rare, organ-specific, a group of blistering disease of skin and mucous membranes. Recent studies suggest that the frequency of the autoimmune bullous diseases has been increasing. Pemphigus vulgaris and bullous pemphigoid are the most frequently reported autoimmune bullous diseases. High incidence of autoimmune bullous diseases in some ethnic groups such as pemphigus in Ashkenazi Jewish, or in some regions such as pemphigus foliaceus in Brazil has been shown to be related to genetic and environmental factors, respectively. Pemphigus has been reported more frequently in the female gender. Although it is most frequently diagnosed between the ages 50 and 60 in European countries, in the remaining countries in the world, it is seen between the ages of 30 and 50. Bullous pemphigoid is generally seen above 70 years of age. Although overall incidence is slightly higher in females, after the age of 80 years it is more frequent in males. Both pemphigus vulgaris and bullous pemphigoid has a chronic course with recurrences. Mortality risk of the patients with bullous pemphigoid was found at least 2 times higher and the mortality risk of the patients with pemphigus was found approximately 3 times higher than that of the general population. In this review, the results obtained from the epidemiological studies were analyzed according to geographic regions, and especially epidemiologic features of two prevalent autoimmune bullous diseases, pemphigus and bullous pemphigoid have been discussed.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey,
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Saleh MA. Pemphigus in the Arab world. J Dermatol 2015; 42:27-30. [DOI: 10.1111/1346-8138.12676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
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Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis 2014; 9:136. [PMID: 25178359 PMCID: PMC4154519 DOI: 10.1186/s13023-014-0136-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Gestational pemphigoid (pemphigoid gestationis, PG) is a rare autoimmune skin disorder occurring characteristically during pregnancy. Autoantibodies against placental BP180 (also known as BPAG2 or collagen XVII) cause damage to the skin basement membrane, resulting in severe itching and blistering rash over the body and the extremities. The diagnosis of PG is confirmed by immunofluorescence analysis of a skin biopsy, while serum levels of pemphigoid antigen BP180 antibody can be used to assess disease activity. PG with mild symptoms can be treated with topical corticosteroids, while oral corticosteroids are the mainstay in treatment of severe PG. PG usually flares up at the time of delivery, and resolves spontaneously shortly after. However, relapses in subsequent pregnancies are common. As PG has been linked to the risk of prematurity and fetal growth restriction, prenatal monitoring jointly by a dermatologist and an obstetrician is recommended. Mothers should also be informed of the potential risk of re-activation of the disease in subsequent pregnancies and during hormonal contraception.
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Affiliation(s)
- Laura Huilaja
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaarin Mäkikallio
- />Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaisa Tasanen
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
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Buch AC, Kumar H, Panicker N, Misal S, Sharma Y, Gore CR. A Cross-sectional Study of Direct Immunofluorescence in the Diagnosis of Immunobullous Dermatoses. Indian J Dermatol 2014; 59:364-8. [PMID: 25071256 PMCID: PMC4103273 DOI: 10.4103/0019-5154.135488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens, which are components of the desmosomes or adhesion complex at the dermoepidermal junction. Direct immunofluorescence (DIF) is invaluable in the diagnosis of these lesions. Aim: The aim of this study was to evaluate the sensitivity of DIF in immunobullous dermatoses and to study the pattern of DIF. The study also aims to correlate DIF with clinical and histologic findings and to analyze discrepancies. Materials and Methods: Total 100 biopsies received over a period of 2 years in the Department of Pathology were analyzed. DIF, histopathology and clinical data were reviewed. Results: Out of 100, 89 cases showed DIF patterns concordant with clinical/histologic diagnosis. The sensitivity of DIF was 94.44% (51/58) in the pemphigus and 84% (21/25) in the bullous pemphigoid (BP) group, 100% each in dermatitis herpetiformis (2/2) and linear IgA disease (1/1). A total of 11 histologically proven cases of immunobullous lesions were DIF negative-four (three of pemphigus vulgaris and one of BP) due to having no epidermis, three (cases of BP) owing to sampling/technical errors and the remaining four (cases of pemphigus vulgaris) due to being on treatment. Conclusion: Immunofluorescence helps confirm the diagnosis of bullous lesions in which there is clinical and the histopathologic overlap. Sampling errors contributed to false negative (FN) results.
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Affiliation(s)
- Archana C Buch
- Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
| | - Harsh Kumar
- Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
| | - Nk Panicker
- Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
| | - Sonali Misal
- Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
| | - Yk Sharma
- Department of Dermatology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
| | - Charusheela R Gore
- Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, India
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