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Martins NF, Dos Santos RTN, Azevêdo ABF, de Sousa Duda Júnior LG, de Vasconcelos AJA, Sobral APV. Comparative Analysis Of The Prevalence Of Oral Manifestations Between Pemphigus Vulgaris And Mucous Membrane Pemphigoid: Scoping Review. Arch Dermatol Res 2024; 316:166. [PMID: 38734829 DOI: 10.1007/s00403-024-02925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/09/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Nathalya Fedechen Martins
- Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, R. Monsenhor Furtado, S/N - Rodolfo Teófilo, Ceará, Fortaleza, Brazil.
| | | | | | | | - Ana Júlia Alves de Vasconcelos
- Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, R. Monsenhor Furtado, S/N - Rodolfo Teófilo, Ceará, Fortaleza, Brazil
| | - Ana Paula Veras Sobral
- Department of Oral and Maxillofacial Pathology, University of Pernambuco, Recife, Brazil
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Polat AK, Mülayim MK, Gür TF, Acar A, Bozca BC, Ceylan C, Kılınç F, Güner RY, Albayrak H, Durdu M, Aksu AEK, Nalbant F, Şavk E, Bayramgürler D, Daye M, Singer R, Alataş ET, Erdemir VA, Gürel MS, Uzun S, Yaylı S. Evaluation of the Quality of Life and the Demographic and Clinical Characteristics of Patients With Pemphigus With Oral Mucosal İnvolvement: A Multicenter Observational Study. Dermatol Pract Concept 2024; 14:dpc.1402a99. [PMID: 38810063 PMCID: PMC11135935 DOI: 10.5826/dpc.1402a99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Pemphigus vulgaris (PV) is an autoimmune disease primarily affecting the oral mucosa. OBJECTIVES This study aimed to determine the demographic, clinical and treatment characteristics of PV patients with oral mucosal involvement and to assess the impact on their quality of life. METHODS We conducted a prospective observational study among 106 patients diagnosed with PV and presenting oral mucosal involvement. Demographic data, clinical and treatment characteristics, and quality of life questionnaires were recorded. RESULTS The study included 106 patients, 55 (51.89%) were male and there was a predominance of the mucocutaneous subtype in 83 individuals (78.38%). Oral mucosa was the initial site of manifestation in 44 patients (41.51%). Bilateral buccal mucosa was the most frequently affected site. The predominant symptom reported was a burning sensation, noted in 91 patients (85.85%). Oral mucosal examination revealed erosions in 85.85% of the patients. Systemic steroids were the most commonly administered treatment, and rituximab was used in 18 patients (16.98%). A positive and significant correlation was found between pemphigus severity and Oral Health Impact Profile-14, Dermatology Life Quality Index and Dermatological Quality of Life Scale scores (P < 0.05). The presence of superficial ulcers, flaccid bullae, lesion diameter ≥1 cm, and >10 lesions were factors that markedly diminished quality of life. Complete response to treatment was noted in all patients administered rituximab. CONCLUSIONS The most common area of involvement was bilateral buccal mucosa, and the severity of PV closely correlated with a decline in quality of life measures. These results highlight the need for careful clinical oversight of PV, taking into account its effects on patients quality of life.
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Affiliation(s)
- Asude Kara Polat
- Memorial Bahçelievler Hospital, Department of Dermatology, Istanbul, Turkey
| | - Mehmet Kamil Mülayim
- Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Dermatology, Kahramanmaraş, Turkey
| | - Tuğba Falay Gür
- University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ayda Acar
- Ege University Faculty of Medicine, Department of Dermatology, İzmir, Turkey
| | - Burçin Cansu Bozca
- Akdeniz University, Faculty of Medicine, Department of Dermatology, Antalya, Turkey
| | - Can Ceylan
- Ege University Faculty of Medicine, Department of Dermatology, İzmir, Turkey
| | - Fadime Kılınç
- Ankara City Hospital, Department of Dermatology, Ankara, Turkey
| | - Rukiye Yasak Güner
- Sivas Cumhuriyet University, Faculty of Medicine, Department of Dermatology, Sivas, Turkey
| | - Hülya Albayrak
- Namık Kemal University Faculty of Medicine, Department of Dermatology, Tekirdağ, Turkey
| | - Murat Durdu
- Başkent University Adana Dr. Turgut Noyan Application and Research Center, Department of Dermatology, Adana, Turkey
| | - Ayşe Esra Koku Aksu
- University of Health Sciences, İstanbul Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Fatma Nalbant
- Edirne Keşan State Hospital, Department of Dermatology, Edirne, Turkey
| | - Ekin Şavk
- Aydın Adnan Menderes University Faculty of Medicine, Department of Dermatology, Aydın, Turkey
| | - Dilek Bayramgürler
- Kocaeli University Faculty of Medicine, Department of Dermatology, Kocaeli, Turkey
| | - Munise Daye
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Dermatology, Konya, Turkey
| | - Ralfi Singer
- Prof. Dr. Cemil Taşcıoğlu City Hospital, Department of Dermatology, Istanbul, Turkey
| | - Emine Tuğba Alataş
- Muğla Sıtkı Koçman University Faculty of Medicine, Faculty of Medicine, Department of Dermatology, Mugla, Turkey
| | - Vefa Aslı Erdemir
- Medeniyet University Faculty of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Medeniyet University Faculty of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Soner Uzun
- Akdeniz University, Faculty of Medicine, Department of Dermatology, Antalya, Turkey
| | - Savaş Yaylı
- Koç University Faculty of Medicine, Department of Dermatology, Istanbul, Turkey
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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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Petruzzi M, Della Vella F, Squicciarini N, Lilli D, Campus G, Piazzolla G, Lucchese A, van der Waal I. Diagnostic delay in autoimmune oral diseases. Oral Dis 2023; 29:2614-2623. [PMID: 36565434 DOI: 10.1111/odi.14480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Autoimmune diseases (ADs) affect about 5% of the general population, causing various systemic and/or topical clinical manifestations. The oral mucosa is often affected, sometimes as the only involved site. The misdiagnosis of oral ADs is an underreported issue. This narrative review focuses on diagnostic delay (DD) in oral ADs (oral lichen planus [OLP], oral Pemphigus Vulgaris, mucous membrane pemphigoid, oral lupus erythematosus, orofacial granulomatosis, oral erythema multiforme [EM], and Sjogren syndrome). Extensive literature research was conducted via MEDLINE, Embase and Google Scholar databases for articles reporting the time spent to achieve the correct diagnosis of oral ADs. Only 16 studies reported DD in oral ADs. Oral autoimmune vesiculobullous diseases are usually diagnosed after 8 months from the initial signs/symptoms, the Sjogren Syndrome diagnosis usually requires about 73 months. No data exist about the DD in OLP, oral lupus erythematosus, orofacial granulomatosis, and oral EM. The diagnosis of oral ADs can be difficult due to the non-specificity of their manifestations and the unawareness of dentists, physicians, and dental and medical specialists about these diseases. This can lead to a professional DD and a consequential treatment delay. The delay can be attributed to the physicians or/and the healthcare system (Professional Delay) or the patient (Patient's Delay).
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Squicciarini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Lilli
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
- School of Dentistry, Sechenov University, Moscow, Russia
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine "G. Baccelli", University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, Naples, Italy
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Patil S, Khan SS, Hosmani J, Khan ZA, Muruganandhan J, Mushtaq S, Yadalam PK, Bhandi S, Awan KH. Identification of oral immune disorders- A review and a diagnostic algorithm. Dis Mon 2023; 69:101350. [PMID: 35337656 DOI: 10.1016/j.disamonth.2022.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Immunological disorders are observed in various clinical presentations in the oral cavity. The pathophysiology of these disorders include but are not limited to primary oral auto-immune disease, systemic disease with oral findings, malignancies, hypersensitivity reactions, drug-induced, and infection-related. Many of these disorders have overlapping oral features, making it difficult for the clinician to diagnose and treat the disorder. There is a need to provide a simple and practical decision-making algorithm to the clinicians and provide them guidance on laboratory investigations. The present review provides a diagnostic algorithm that might minimize outpatient process delays and lead to early management. This is crucial in many cases where oral findings may be the first sign of the disorder, and early treatment can preclude dissemination and complications of the disorder.
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Affiliation(s)
- Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia; Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Samar Saeed Khan
- Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Jagadish Hosmani
- Oral Pathology Division, Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Zafar Ali Khan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Jayanandan Muruganandhan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India
| | - Shazia Mushtaq
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Pradeep Kumar Yadalam
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600 077, India
| | - Shilpa Bhandi
- Department of Restorative Dental Science, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Kamran Habib Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States.
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Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7583691. [PMID: 36164397 PMCID: PMC9509267 DOI: 10.1155/2022/7583691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
Background Treating oral mucosal lesions of Pemphigus Vulgaris (PV) disease is usually challenging for clinicians. We studied the treatment outcomes of the oral PV patients referred to the Oral Medicine Department of Shiraz University of Medical Sciences from 2004 to 2018. Methods The medical records of 54 oral PV patients with histopathological confirmation who were treated by a single protocol were studied. The protocol consisted of initial treatment with 1 mg/kg/day of oral prednisolone for all patients. After 4–6 weeks, all patients were prescribed 40 mg of prednisolone. If lesion recovery was not observed or new lesions had developed, adjuvant therapy (maximum dose of 200 mg per day of Azathioprine (AZA)) was initiated anytime during the treatment. The oral prednisolone dosage was gradually tapered to 5 mg/alternate day in 9 months. Results 47 patients were included in the study. 34.04% were male and 65.96% were female with a mean age of 41.83 ± 12.520. The mean follow-up period was 50.806 ± 44.417 months (over 4 years). The severity of oral involvement was mild in 21.27%, moderate in 36.17%, and severe in 42.6%. During treatment, all patients except one experienced complete remission. The mean time to achieve complete remission was 150.39 ± 224.075 days. Most of the patients experienced relapse due to self-discontinuation of treatment. 55% had complete remission and 43% were in partial remission at the last follow-up session. In 65.96% of patients, treatment-associated side effects were observed. The patients treated with prednisolone alone had significantly more side effects than those using AZA as an adjuvant (80% vs 50%, respectively; P=0.030). The mean duration of follow-ups was longer for patients with side effects (P < 0.01). Topical corticosteroids were used for all patients sometime during the treatment. No deaths were recorded. Conclusion Prescribing low-dose prednisolone and adding AZA in nonresponding cases has good clinical outcomes for the treatment of oral lesions of PV. Adjuvant therapy can avoid the increase in corticosteroid dosage and side effects. The treatment method described in this study can be a helpful guide for clinicians, especially when other immunosuppressive drugs are not available.
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7
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Magdy E, Shafik S, Saadany BEL. Platelet rich fibrin a new approach in management of persistent oral ulcers in blistering skin diseases. Wound Repair Regen 2022; 30:491-497. [PMID: 35589608 DOI: 10.1111/wrr.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Eman Magdy
- Lecturer of Oral medicine, diagnosis and periodontology, Faculty of Dentistry, Beni-Suef University, Beni-Suef, Egypt
| | - Sherif Shafik
- Lecturer of Oral and Maxillofacial Radiology, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt
| | - Basma E L Saadany
- Lecturer of Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
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8
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Batistella EÂ, Sabino da Silva R, Rivero ERC, Silva CAB. Prevalence of oral mucosal lesions in patients with pemphigus vulgaris: A systematic review and meta-analysis. J Oral Pathol Med 2021; 50:750-757. [PMID: 33713362 DOI: 10.1111/jop.13167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the prevalence of oral mucosal lesions in patients with Pemphigus Vulgaris. METHODS Observational studies reporting the prevalence of oral lesions in pemphigus vulgaris patients, without restriction to language and year of publication, were selected in a two-phase process. Search strategies were applied to PubMed, Scopus, Livivo, Web of Science, LILACS, Google Scholar, and OpenGrey databases. Articles assessing the prevalence of oral lesions in patients with conditions other than pemphigus vulgaris were excluded. Risk of bias analysis was performed using the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data. Synthesis of results was calculated by the software R Statistics version 4.0.2 (The R Foundation). Confidence in cumulative evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS From 1957 studies identified, 40 were included in qualitative synthesis and 38 in meta-analyses. The pooled prevalence of patients with oral lesions solely or concurrent with other mucocutaneous lesions was 90.3%. The prevalence of patients with exclusive oral mucosal lesions was 50.8%. Risk of bias was considered low, and the certainty of evidence was very low. CONCLUSION Oral lesions were present in approximately nine out of 10 patients with pemphigus vulgaris. The oral mucosa was the most common site of disease onset. Further longitudinal studies are urged to assess the prevalence of oral lesions at different disease stages.
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Affiliation(s)
- Elis Ângela Batistella
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Rayssa Sabino da Silva
- Dentistry School, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Carolina Amália Barcellos Silva
- Department of Morphological Sciences, Biological Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
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Mahmoudi H, Tavakolpour S, Balighi K, Farid AS, Nili A, Jan D, Daneshpazhooh M. Rituximab in practice: Clinical evaluation of patients with pemphigus after rituximab administration. Dermatol Ther 2020; 34:e14633. [PMID: 33280226 DOI: 10.1111/dth.14633] [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: 10/30/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)-a B-cell depleting agent-for the management of patients with moderate-to-severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, nonresponders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after 3 months, reaching remission until 6 months, and the ability of corticosteroid tapering in 6 months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long-term side effects are discussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time-points, including 1, 2, 3, and 6 months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.
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Affiliation(s)
- Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Delnavaz Jan
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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10
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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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11
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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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12
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Arduino PG, Broccoletti R, Carbone M, Conrotto D, Sciannameo V, Gambino A, Cabras M, Carrozzo M, Baldovino S. The prompt use of rituximab could decrease adverse effects in patient with pemphigus vulgaris: A preliminary evaluation. J Oral Pathol Med 2019; 49:177-180. [DOI: 10.1111/jop.12982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Paolo G. Arduino
- Department of Surgical Sciences CIR‐Dental School University of Turin Italy
| | | | - Mario Carbone
- Department of Surgical Sciences CIR‐Dental School University of Turin Italy
| | - Davide Conrotto
- Department of Surgical Sciences CIR‐Dental School University of Turin Italy
| | | | | | - Marco Cabras
- Department of Surgical Sciences CIR‐Dental School University of Turin Italy
| | - Marco Carrozzo
- Department of Oral Medicine School of Dental Sciences University of Newcastle upon Tyne Newcastle upon Tyne UK
| | - Simone Baldovino
- Department of Clinical and Biological Sciences Center of Research of Immunopathology and Rare Diseases‐Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley University of Turin Turin Italy
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Fortuna G, Calabria E, Ruoppo E, Adamo D, Aria M, Amato M, Mignogna MD. The use of rituximab as an adjuvant in the treatment of oral pemphigus vulgaris. J Oral Pathol Med 2019; 49:91-95. [DOI: 10.1111/jop.12951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
- D.eb.RA. Mexico Foundation Guadalupe N.L., Monterrey Mexico
- Federico Navarro Institute – School of Orgonomy “Piero Borrelli” Naples Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
| | - Elvira Ruoppo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
| | - Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
| | - Massimo Aria
- Department of Economics and Statistics Federico II University of Naples Naples Italy
| | - Massimo Amato
- Department of Medicine, Surgery and Dentistry University of Salerno Fisciano Italy
| | - Michele D. Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
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