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Sriram S, Hasan S, Mansoori S, Saeed S, Banerjee A, Ramalingam K. Juvenile pemphigus vulgaris: Literature review and a rare case report. Clin Case Rep 2024; 12:e8954. [PMID: 38756617 PMCID: PMC11096281 DOI: 10.1002/ccr3.8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion affecting the skin and mucous membranes, predominantly affects females in their fifth and sixth decades of life. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. PV should always be considered in the differential diagnosis of oral ulcerative and vesiculobullous lesions in both children and adolescents.
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Affiliation(s)
| | - Shamimul Hasan
- Department of Oral Medicine and RadiologyFaculty of Dentistry, Jamia Millia IslamiaNew DelhiIndia
| | - Shahnaz Mansoori
- Department of Oral Medicine and RadiologyFaculty of Dentistry, Jamia Millia IslamiaNew DelhiIndia
| | - Shazina Saeed
- Amity Institute of Public Health & Hospital AdministrationAmity UniversityNoidaUttar PradeshIndia
| | - Abhishek Banerjee
- Oral and Maxillofacial PathologyAwadh Dental College and HospitalJamshedpurJharkhandIndia
| | - Karthikeyan Ramalingam
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
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Shrivastava P, Mariam S, Abid L, Buch SA, Ahmad SA, Mansoori S, Hasan S. Rituximab in Childhood and Juvenile Pemphigus Vulgaris: A Systematic Review. Cureus 2024; 16:e58288. [PMID: 38752055 PMCID: PMC11094568 DOI: 10.7759/cureus.58288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion, affecting the skin and mucous membranes. Both males and females are affected, although it predominantly affects females in their fifth and sixth decades of life. Approximately 1.4 to 3.7% of PV cases occur in the pediatric population (≤18 years of age), and may be classified into childhood/pediatric PV, which affects individuals under 12 years old, and juvenile/adolescent PV, affecting those between 12 and 18 years old. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. A systematic literature search was conducted on MEDLINE/PubMed, Web of Science, EMBASE, SCOPUS, and Cochrane Library databases to evaluate the efficacy of rituximab (RTX) in childhood and juvenile PV patients. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was employed to assess the risk of bias in case reports and series, while the Cochrane ROBINS-I tool was utilized for evaluating observational studies or non-randomized intervention studies. A total of 18 studies encompassing 46 juvenile or childhood PV patients in the pediatric and adolescent age groups were included for qualitative synthesis. The studies included nine case reports, two case series, five retrospective studies, one prospective study, and one open-label pilot study. Almost all cases of childhood and juvenile PV achieved either complete or partial remission after undergoing RTX treatment during the final follow-up periods. Furthermore, most cases reported no relapse, and only minor adverse events were noted in the RTX treatment group. Despite its potential benefits, the utilization of RTX in pediatric patients raises concerns due to the scarcity of evidence and the absence of controlled studies specific to this age group. Further exploration is necessary to establish a standardized treatment regimen for RTX in pediatric PV, which involves identifying the optimal dosage, frequency, treatment cycle duration, and maintenance therapy duration.
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Affiliation(s)
| | - Sarah Mariam
- Periodontology, Bharati Vidyapeeth Deemed To Be University, Pune, IND
| | - Laraib Abid
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| | - Sajad A Buch
- Clinical Oral Health Sciences, School of Dentistry, IMU University, Kuala Lumpur, MYS
| | - Syed A Ahmad
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| | | | - Shamimul Hasan
- Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
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Does Diabetes Induce the Vascular Endothelial Growth Factor (VEGF) Expression in Periodontal Tissues? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082765. [PMID: 32316357 PMCID: PMC7215273 DOI: 10.3390/ijerph17082765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
Aim: Diabetes and periodontal disease are both chronic pathological conditions linked by several underlying biological mechanisms, in which the inflammatory response plays a critical role, and their association has been largely recognized. Recently, attention has been given to diabetes as an important mediator of vascular endothelial growth factor (VEGF) overexpression in periodontal tissues, by virtue of its ability to affect microvasculature. This review aims to summarize the findings from studies that explored VEGF expression in diabetic patients with periodontitis, compared to periodontally healthy subjects. Materials and Methods: A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PubMed search of select medical subject heading (MeSH) terms was carried out to identify all studies reporting findings about VEGF expression in periodontal tissues of diabetic patients up to May 2018. The inclusion criteria were studies on VEGF expression in periodontally diseased tissues of diabetic patients compared with nondiabetic subjects, with any method of analysis, and published in the English language. Results: Eight articles met the inclusion criteria. Immunohistochemistry was used in six of the studies, reverse transcriptase polymerase chain reaction (real-time RT-PCR) aiming to quantify mRNA VEGF expression was used in one study, and ELISA analysis was used for one study. Compared with nondiabetic patients, a higher VEGF expression in gingival tissue and gingival crevicular fluid (GCF) samples in diabetic patients with periodontitis was reported. Conclusions: Overall, novel evidence for the VEGF expression within the periodontal tissue of diabetic patients paves the way for further studies on the role of this protein in neovascularization physiology and pathophysiology in microvasculature of the periodontium.
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Rapone B, Converti I, Santacroce L, Cesarano F, Vecchiet F, Cacchio L, Scacco S, Grassi R, Grassi FR, Gnoni A, Ferrara E, Nardi GM. Impact of Periodontal Inflammation on Nutrition and Inflammation Markers in Hemodialysis Patients. Antibiotics (Basel) 2019; 8:antibiotics8040209. [PMID: 31683838 PMCID: PMC6963174 DOI: 10.3390/antibiotics8040209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Malnutrition-inflammation complex syndrome (MICS) is a common and usually concurrent condition occurring in patients undergoing hemodialysis (HD), with a pathogenesis linked to biological and in situ environmental traditional risk factors. Periodontitis, one of the major types of infection-driven inflammation, often co-occurs in the in the hemodialysis population and correlates with markers of malnutrition and inflammation, such as albumin, creatinine, and C-reactive protein. Aim: The present study aimed to determine whether the periodontal inflammatory status parameters correlate with the albumin, creatinine, and C-reactive protein serum concentrations in HD patients, and investigate whether periodontal treatment improves these markers of nutritional and systemic inflammation. Materials and Methods: The serum creatinine, albumin, and C-reactive Protein (CRP) levels were measured at baseline and after non-surgical periodontal treatment, at 3 months and 6 months. Results: At 3 months, a significant correlation between plaque index and C-reactive protein (p = 0.012), bleeding on probing and C-reactive protein (p < 0.0019), and clinical attachment level and C-reactive protein (p = 0.022) was found. No significant correlation was found between clinical periodontal parameters and nutrition markers at each time. Conclusions: Our results confirmed the association between C-reactive protein serum concentration and periodontal inflammatory status, but further research is necessary to identify the contributing role of periodontitis on the onset and progression of MICS.
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Affiliation(s)
- Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70122 Bari, Italy; (S.S.); (F.R.G.); (A.G.)
- Correspondence: (B.R.); (L.S.); Tel.: +39-3477619817 (B.R.)
| | - Ilaria Converti
- Department of Emergency and Organ Transplantation, Division of Plastic and Reconstructive Surgery, “Aldo Moro” University of Bari, 70122 Bari, Italy;
| | - Luigi Santacroce
- Ionian Department (DJSGEM), “Aldo Moro” University of Bari, 70122 Bari, Italy
- Correspondence: (B.R.); (L.S.); Tel.: +39-3477619817 (B.R.)
| | - Francesca Cesarano
- Department of Dental and Maxillofacial Sciences, “Sapienza” University of Rome, 00100 Rome, Italy; (F.C.); (G.M.N.)
| | - Federico Vecchiet
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy; (F.V.); (L.C.); (E.F.)
| | - Luciano Cacchio
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy; (F.V.); (L.C.); (E.F.)
| | - Salvatore Scacco
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70122 Bari, Italy; (S.S.); (F.R.G.); (A.G.)
| | - Roberta Grassi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Felice Roberto Grassi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70122 Bari, Italy; (S.S.); (F.R.G.); (A.G.)
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70122 Bari, Italy; (S.S.); (F.R.G.); (A.G.)
| | - Elisabetta Ferrara
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy; (F.V.); (L.C.); (E.F.)
| | - Gianna Maria Nardi
- Department of Dental and Maxillofacial Sciences, “Sapienza” University of Rome, 00100 Rome, Italy; (F.C.); (G.M.N.)
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Rapone B, Ferrara E, Santacroce L, Cesarano F, Arazzi M, Liberato LD, Scacco S, Grassi R, Grassi FR, Gnoni A, Nardi GM. Periodontal Microbiological Status Influences the Occurrence of Cyclosporine-A and Tacrolimus-Induced Gingival Overgrowth. Antibiotics (Basel) 2019; 8:antibiotics8030124. [PMID: 31438651 PMCID: PMC6784123 DOI: 10.3390/antibiotics8030124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 12/14/2022] Open
Abstract
Immune suppressed renal transplant patients are more prone to developing oral tissue alterations due to medications associated with a pleiotropic set of side effects involving the oral cavity. Drug-induced gingival overgrowth (DIGO) is the most commonly encountered side effect resulting from administration of calcineurin inhibitors such as cyclosporine-A (CsA), the standard first-line treatment for graft rejection prevention in transplant patients. Pathogenesis of gingival overgrowth (GO) is determined by the interrelation between medications and a pre-existing inflammatory periodontal condition, the main modifiable risk factor. Severity of gingival hyperplasia clinical manifestation is also related to calcium channel blocker association, frequently provided in addition to pharmacological therapy of transplant recipients. Specifically, nifedipine-induced enlargements have a higher prevalence rate compared to amlodipine-induced enlargements; 47.8% and 3.3% respectively. Available epidemiological data show a gender difference in prevalence, whereby males are generally more frequently affected than females. The impact of GO on the well-being of an individual is significant, often leading to complications related to masticatory function and phonation, a side effect that may necessitate switching to the tacrolimus drug that, under a similar regimen, is associated with a low incidence of gingival lesion. Early detection and management of GO is imperative to allow patients to continue life-prolonging therapy with minimal morbidity. The purpose of this study was threefold: firstly, to determine the prevalence and incidence of GO under the administration of CsA and Tacrolimus; secondly, to assess the correlation between periodontal status before and after periodontal therapy and medications on progression or recurrence of DIGO; and finally, to analyse the effect of immunosuppressant in association to the channel blocker agents on the onset and progression of gingival enlargement. We compared seventy-two renal transplant patients, including 33 patients who were receiving CsA, of which 25% were also receiving nifedipine and 9.72% also receiving amlodipine, and 39 patients who were receiving tacrolimus, of which 37.5% were also receiving nifedipine and 5.55% also receiving amlodipine, aged between 35 and 60 years. Medical and pharmacological data were recorded for all patients. Clinical periodontal examination, in order to establish the inflammatory status and degree of gingival enlargement, was performed at baseline (T0), 3 months (T1), 6 months (T2), and 9 months (T3). All patients were subjected to periodontal treatment. Statistically significant correlation between the reduction of the mean value of periodontal indices and degree of gingival hyperplasia at the three times was revealed. The prevalence of GO in patients taking cyclosporine was higher (33.3%) in comparison with those taking tacrolimus (14.7%). In accordance with previous studies, this trial highlighted the clinical significance of the pathological substrate on stimulating drug-induced gingival lesion, confirming the key role of periodontal inflammation in pathogenesis of gingival enlargement, but did not confirm the additional effect of calcium-channel blocker drugs in inducing gingival enlargement.
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Affiliation(s)
- Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70122 Bari, Italy.
| | - Elisabetta Ferrara
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy
| | - Luigi Santacroce
- Ionian Department (DJSGEM), "Aldo Moro" University of Bari, 70122 Bari, Italy.
| | - Francesca Cesarano
- Department of Dental and Maxillofacial Sciences, "Sapienza" University of Rome, 00100 Rome, Italy
| | - Marta Arazzi
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy
| | - Lorenzo Di Liberato
- Complex Operative Unit of Nephrology and Dialysis, Hospital S.S. Annunziata, 66100 Chieti, Italy
| | - Salvatore Scacco
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70122 Bari, Italy
| | - Roberta Grassi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Felice Roberto Grassi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70122 Bari, Italy
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70122 Bari, Italy
| | - Gianna Maria Nardi
- Department of Dental and Maxillofacial Sciences, "Sapienza" University of Rome, 00100 Rome, Italy
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