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Iovene FR, Santinelli E, Armiento D, Sarlo C, Bancone C, Silvestri L, Erculei S, Sanhust MG, Cristiano A, Fabiani E, Divona M, Page C, Di Zenzo G, Cantonetti M, Rigacci L. Acute myeloid leukemia with paraneoplastic pemphigus successfully treated with a personalized antileukemic and immunosuppressive strategy. Ann Hematol 2024; 103:2545-2549. [PMID: 38780802 DOI: 10.1007/s00277-024-05804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Bullous pemphigoid (BP) is a rare blistering disease often considered a primary sign of a paraneoplastic syndrome. Retrospective studies have established its link with hematological malignancies, particularly lymphoproliferative disorders. Here, we present what we believe to be the inaugural case of successful simultaneous management of BP and de novo acute myeloid leukemia (AML) in a 28-year-old male patient. Given the rarity and severity of both conditions, our treatment strategy aimed to maximize efficacy by combining immunosuppressive therapy (initially plasmapheresis with high-dose corticosteroids, followed by anti-CD20 monoclonal antibody and intravenous immunoglobulins 2 g/m2) with lymphodepleting antileukemic chemotherapy utilizing Fludarabine (FLAG-IDA induction regimen). Following diagnosis, considering the patient's youth and the concurrent presence of two rare and potentially life-threatening diseases, we opted for an aggressive treatment. Upon achieving complete morphological remission of AML with measurable residual disease (MRD) negativity, despite incomplete resolution of BP, we proceeded with high-dose cytarabine consolidation followed by peripheral stem cell harvest and autologous stem cell transplantation (ASCT). Our conditioning regimen for ASCT involved Bu-Cy with the addition of anti-thymocyte globulins. At day + 100 post-ASCT, bone marrow evaluation confirmed morphological remission and MRD negativity. Meanwhile, BP had completely resolved with normalization of BP180 antibody levels.
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Affiliation(s)
- Francesca Romana Iovene
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy.
- Research Unit of Hematology and Stem Cell Transplantation, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
| | - Enrico Santinelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Department of Biomedicine and Prevention, PhD program in Immunology, Molecular Medicine and Applied Biotechnologies, Tor Vergata University, Rome, Italy
| | - Daniele Armiento
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
| | - Chiara Sarlo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
| | - Chiara Bancone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Hematology and Stem Cell Transplantation, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | | | | | | | - Antonio Cristiano
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Department of Biomedicine and Prevention, PhD program in Immunology, Molecular Medicine and Applied Biotechnologies, Tor Vergata University, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | - Camilla Page
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | | | - Luigi Rigacci
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Hematology and Stem Cell Transplantation, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Ramesh P, Divyambika CV, Warrier AS, Joseph LD. Clinical management of bullous pemphigoid-The importance of cytology in diagnosis. J Oral Maxillofac Pathol 2024; 28:328-331. [PMID: 39157830 PMCID: PMC11329080 DOI: 10.4103/jomfp.jomfp_544_23] [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] [Received: 12/22/2023] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 08/20/2024] Open
Abstract
Bullous pemphigoid (BP) is a common immune-mediated blistering disorder with predominant skin involvement and occasionally oral manifestations. Vesiculobullous lesions of the oral mucosa present with similar clinical features, and hence arriving at a clinical diagnosis is aided by a valuable chairside investigation, exfoliative cytology. Cytology done in the present case ruled out pemphigus because of the absence of Tzanck cells in the smear. Biopsy and direct immunofluorescence further confirmed the diagnosis of BP. Treatment initiated with systemic steroids and immunomodulators, along with oral topical application of triamcinolone acetonide resulted in complete remission in 2 months. This case report highlights the role of cytology in the diagnosis of vesiculobullous lesions and management protocol for BP patients presenting with simultaneous skin and oral lesions.
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Affiliation(s)
- Preethi Ramesh
- Department of Oral Medicine and Radiology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - CV Divyambika
- Department of Oral Medicine and Radiology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Aravind S. Warrier
- Department of Oral Medicine and Radiology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Department of General Pathology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India
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Bartholow AH. Fiberoptic endoscopic assessment of dysphagia in a patient with cutaneous and oropharyngeal blisters. Clin Case Rep 2024; 12:e8660. [PMID: 38487636 PMCID: PMC10940005 DOI: 10.1002/ccr3.8660] [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: 06/13/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Dysphagia resulting from bulbous pemphigoid is a rare but significant manifestation. A 77-year-old with bullous pemphigoid with no neurological history presented with severe oropharyngeal dysphagia, attributable to underlying blistering and edema, as documented on a fiberoptic endoscopic swallow examination.
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Akel M, Wright M, Aladum B, Hernandez Borges S. Beyond the Surface: A Clinical Insight Into a 60-Year-Old Male With Pemphigus vulgaris. Cureus 2024; 16:e54408. [PMID: 38505433 PMCID: PMC10948956 DOI: 10.7759/cureus.54408] [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: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
Pemphigus vulgaris, a rare and life-threatening autoimmune disorder, presents with painful skin and mucosal lesions, leading to blistering sores attributed to acantholysis. This study delves into the clinical manifestations, risk factors, and diagnostic intricacies associated with pemphigus vulgaris, with a focus on a representative case highlighting the challenges in its recognition and management. We explore the case of a 60-year-old male with pemphigus vulgaris, whose initial presentation involved yellow-crusting lesions on the scalp progressing to non-pruritic lesions on the chest, neck, and inguinal areas. A multidisciplinary medical workup was conducted, encompassing serological tests, imaging, and consultations with infectious disease and dermatology specialists. The definitive diagnosis was established through histopathological examination of three 4-mm punch biopsies. The case underscores the polymorphic nature of pemphigus vulgaris, with diverse clinical presentations and diagnostic challenges. The positive Nikolsky sign on the chest and neck lesions, coupled with oral mucosal involvement observed during a routine dental procedure, exemplifies the complexity of its manifestations. Diagnostic intricacies involved negative results for infectious diseases, declined kidney function, and elevated inflammatory markers, necessitating a collaborative approach for accurate diagnosis. Pemphigus vulgaris demands a comprehensive understanding of its varied presentations and collaboration among medical specialties for accurate diagnosis and tailored management. Treatment involves systemic glucocorticoids and immunomodulators. The presented case underscores the need for continued research to enhance diagnostic accuracy and refine therapeutic interventions for this rare autoimmune disorder.
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Affiliation(s)
- Miis Akel
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Maggie Wright
- Dermatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Miami, USA
| | - Bialo Aladum
- Psychiatry, Ascension Borgess Hospital, Kalamazoo, USA
| | - Sergio Hernandez Borges
- Internal Medicine, Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Liu M, Yuan M, Sun W, Li Z, Zhou X, Wang C. Clinical characterization, treatment, and outcome of nivolumab-induced bullous pemphigoid. Invest New Drugs 2023; 41:802-807. [PMID: 37773473 DOI: 10.1007/s10637-023-01397-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: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is a serious and rare complication of nivolumab. This study aimed to explore the clinical characteristics of nivolumab-induced BP and provide a reference for prevention and treatment of BP. METHODS Literature on nivolumab-induced BP was collected for retrospective analysis by searching both Chinese and English databases as of July 31, 2023. RESULTS Sixty patients were included, with a median age of 71 years (range 30 to 85 years), and they were predominantly male (78.3%). The median time to onset of BP was 31 weeks (range 2.4, 216) after nivolumab administration. Tense bullae (93.3%), pruritus (55.0%), and urticarial plaques (31.7%) were the most common manifestations. Lesions were found on the limbs (50.0%), trunk (38.3%), palms and soles (15.0%). Skin biopsies mainly showed subepidermal bullous/blister (50.0%) and eosinophilic infiltration (46.7%). Direct immunofluorescence showed mainly linear deposition of C3 and IgG (46.7%) at the dermal-epidermal junction. The patients stopped taking nivolumab and received systemic steroids (73.3%), topical steroids (63.3%), monoclonal antibodies (21.7%), doxycycline/minocycline (30.0%) and other treatments. Symptoms improved or were relieved in 88.4% of patients but did not improve in 8.3% of patients. CONCLUSION Clinicians should closely monitor symptoms of BP in those receiving and discontinuing nivolumab, especially in older men. Early diagnosis and timely initiation of treatment may improve patient outcomes.
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Affiliation(s)
- Miao Liu
- Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410011, China
| | - Maoye Yuan
- Department of pharmacy, Yinan County People's Hospital, Linyi, Shandong, 276300, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, Hunan, 410013, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, Hunan, 410013, China
| | - Xingchen Zhou
- Department of Pharmacy, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, Hunan, 410013, China.
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Oguro S, Echizen K, Sakakibara E, Koshiyama D, Oji T, Miyake T, Kasai K. Clozapine-induced pemphigus successfully treated with methylprednisolone pulse without discontinuation of clozapine: a case report. Psychiatry Clin Neurosci 2023; 77:572-573. [PMID: 37438873 DOI: 10.1111/pcn.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Saki Oguro
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropsychiatry, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kohei Echizen
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Eisuke Sakakibara
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Koshiyama
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Tomoatsu Oji
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Tomomi Miyake
- Department of Dermatology, University of Tokyo Hospital, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
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Zhang X, Xie Y, Wang L. Rare Cutaneous Side Effects of Imiquimod: A Review on Its Mechanisms, Diagnosis, and Management. Dermatol Ther (Heidelb) 2023; 13:1909-1934. [PMID: 37528289 PMCID: PMC10442311 DOI: 10.1007/s13555-023-00978-0] [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: 04/29/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023] Open
Abstract
As an immune-response modifier, imiquimod can bind to Toll-like receptors on immune cells and enhance innate and adaptive immune responses, exerting potential antitumor and antiviral effects, which led to its approval by the US Food and Drug Administration for the treatment of actinic keratosis, superficial basal cell carcinomas, and anogenital warts, and to its off-label use in treating many other benign and malignant dermatoses. Although topical administration of imiquimod has been considered well tolerated, an increasing number of cutaneous and noncutaneous side effects are being reported as its clinical applications expand. This review primarily focuses on rare cutaneous side effects. To the best of our knowledge, this is the first article to summarize the mechanism, diagnosis, and management of rare cutaneous side effects of imiquimod, which may help to heighten awareness among physicians, especially dermatologists, about potential imiquimod-induced cutaneous side effects.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yao Xie
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lin Wang
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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8
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Patigaroo SA, Sangoo M, Maqbool T, Qayoom S. Angina Bullosa Hemorrhagica - A Case Series. Indian J Dermatol 2023; 68:563-568. [PMID: 38099116 PMCID: PMC10718240 DOI: 10.4103/ijd.ijd_663_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Angina bullosa hemorrhagica (ABH) is an oral subepithelial blood blister with poorly understood etiopathogenesis, which is not attributable to blood dyscrasias or vesiculobullous disorders. These hemorrhagic bullae spontaneously rupture within minutes to hours, resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. The lesions are usually solitary, and sometimes cause extreme anxiety in patients. Treatment is generally symptomatic. We report a series of four such patients. No treatment was given, except for reassurance and anxiolytics.
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Affiliation(s)
- Suhail A. Patigaroo
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mushtaq Sangoo
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tabish Maqbool
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Seema Qayoom
- Department of Dermatology, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
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Alexandre MI, Garrido PM, Filipe P. Treatment of Diabetes in Bullous Pemphigoid Patients: Where Do We Stand? Dermatol Pract Concept 2023; 13:dpc.1301a63. [PMID: 36892363 PMCID: PMC9946090 DOI: 10.5826/dpc.1301a63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Maria Inês Alexandre
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Pedro Miguel Garrido
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.,University Dermatology Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
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Ozcan Y, Ozlu E, Karagun E, Uyar B, Gamsizkan M. Dermatopathological Correlation of Clinically Challenging Cutaneous Lesions: a Single Center Experience of 2184 Cases. Dermatol Pract Concept 2022; 12:e2022186. [PMID: 36534561 PMCID: PMC9682974 DOI: 10.5826/dpc.1204a186] [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: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Although a trained eye can easily identify typical skin lesions, histopathological examination and clinicopathological correlation are critical in challenging cases. OBJECTIVES The primary objective is to organize the final diagnoses reached following clinicopathological consensus in clinically challenging cutaneous lesions, identifying the most common diagnostic scenarios encountered by dermatopathologists and discussing their diverse differentials submitted by clinicians. The secondary objective is to investigate how the case profile and clinician decision-making processes evolved during the COVID-19 pandemic. METHODS Skin and mucosa samples collected by the dermatology department between 2016 and 2020 were classified based on pathology reports. For frequent diagnoses, preliminary diagnoses stated by clinicians on pathology requisition forms were reviewed. The years preceding and following the first nationally reported COVID-19 case were compared to investigate the pandemic's impact on the distribution of dermatology and dermatopathology cases. RESULTS One thousand nine hundred and eighty-nine reports were classified into 4 major categories: inflammatory (49.8%), neoplastic (30.1%), other diseases (7.1%), and non-diagnostic (12.8%). We further classified inflammatory diseases based on major tissue reaction patterns and neoplasms based on cell origin. We analyzed the leading diagnoses in each category, discussed their differential diagnoses, and provided clinicians with clues to reduce errors in practice. Following the pandemic, the overall number of pathology reports and patient admissions dropped dramatically, with significant changes in case profiles. CONCLUSIONS We presented and discussed the frequently encountered confounding cases to sketch the diagnostic landscape. In the authors' experience, clinicopathological correlation can increase the rate of reaching the diagnosis by up to 75.3%.
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Affiliation(s)
- Yunus Ozcan
- Department of Dermatology, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Emin Ozlu
- Department of Dermatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Ebru Karagun
- Department of Dermatology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Belkiz Uyar
- Department of Dermatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Gamsizkan
- Department of Pathology, Faculty of Medicine, Duzce University, Duzce, Turkey
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Sciuca AM, Toader MP, Stelea CG, Maftei GA, Ciurcanu OE, Stefanescu OM, Onofrei BA, Popa C. Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus-Challenges in the Diagnosis and Treatment. Diagnostics (Basel) 2022; 12:1754. [PMID: 35885656 PMCID: PMC9322493 DOI: 10.3390/diagnostics12071754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Desquamative gingivitis (DG) is a clinical term that describes erythema, desquamation and erosions of the gingiva, of various etiologies. Although the clinical aspect is not specific for a certain disease, an accurate diagnosis of the underlying disorder is necessary because the disease course, prognosis and treatment vary according to the cause. DG may inflict significant oral discomfort, which is why patients typically present to the dentist for a first consultation, rendering it important for these specialists to be informed about this condition. Our paper aims to review the ethiopatogenesis and diagnostic approach of DG, focusing on the most common underlying disorders (autoimmune bullous dermatoses and lichen planus) and on the management of these patients. Potential etiological agents leading to an inflammatory immune response in the oral mucosa and DG appearance include genetic predisposition, metabolic, neuropsychiatric, infectious factors, medication, dental materials, graft-versus-host reaction and autoimmunity. A thorough anamnesis, a careful clinical examination, paraclinical explorations including histopathological exam and direct immunofluorescence are necessary to formulate an appropriate diagnosis. Proper and prompt management of these patients lead to a better prognosis and improved quality of life, and must include management in the dental office with sanitizing the oral cavity, instructing the patient for rigorous oral hygiene, periodic follow-up for bacterial plaque detection and removal, as well as topical and systemic therapy depending on the underlying disorder, based on treatment algorithms. A multidisciplinary approach for the diagnosis and follow-up of DG in the context of pemphigus vulgaris, bullous pemphigoid, cicatricial pemhigoid or lichen planus is necessary, including consultations with dermatologists, oral medicine specialists and dentists.
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Affiliation(s)
- Ana Maria Sciuca
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Mihaela Paula Toader
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Carmen Gabriela Stelea
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - George Alexandru Maftei
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Oana Elena Ciurcanu
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - Ovidiu Mihail Stefanescu
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - Bianca-Andreea Onofrei
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Cristina Popa
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
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Kulcsarova K, Baloghova J, Necpal J, Skorvanek M. Skin Conditions and Movement Disorders: Hiding in Plain Sight. Mov Disord Clin Pract 2022; 9:566-583. [PMID: 35844274 PMCID: PMC9274368 DOI: 10.1002/mdc3.13436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Skin manifestations are well-recognized non-motor symptoms of Parkinson's disease (PD) and other hypokinetic and hyperkinetic movement disorders. Skin conditions are usually well visible during routine clinical examination and their recognition may play a major role in diagnostic work-up. In this educational review we: (1) briefly outline skin conditions related to Parkinson's disease, including therapy-related skin complications and their management; (2) discuss the role of skin biopsies in early diagnosis of PD and differential diagnosis of parkinsonian syndromes; and focus more on areas which have not been reviewed in the literature before, including (3) skin conditions related to atypical parkinsonism, and (4) skin conditions related to hyperkinetic movement disorders. In case of rare hyperkinetic movement disorders, specific dermatological manifestations, like presence of angiokeratomas, telangiectasias, Mongolian spots, lipomas, ichthyosis, progeroid skin changes and others may point to a very specific group of disorders and help guide further investigations.
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Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Janette Baloghova
- Department of DermatovenerologyMedical Faculty, University of Pavol Jozef SafarikKosiceSlovak Republic
- Department of DermatovenerologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Jan Necpal
- Department of NeurologyZvolen HospitalZvolenSlovak Republic
| | - Matej Skorvanek
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
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Chu KY, Yu HS, Yu S. Current and Innovated Managements for Autoimmune Bullous Skin Disorders: An Overview. J Clin Med 2022; 11:3528. [PMID: 35743598 PMCID: PMC9224787 DOI: 10.3390/jcm11123528] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Autoimmune bullous skin disorders are a group of disorders characterized by the formation of numerous blisters and erosions on the skin and/or the mucosal membrane, arising from autoantibodies against the intercellular adhesion molecules and the structural proteins. They can be classified into intraepithelial or subepithelial autoimmune bullous dermatoses based on the location of the targeted antigens. These dermatoses are extremely debilitating and fatal in certain cases, depending on the degree of cutaneous and mucosal involvement. Effective treatments should be implemented promptly. Glucocorticoids serve as the first-line approach due to their rapid onset of therapeutic effects and remission of the acute phase. Nonetheless, long-term applications may lead to major adverse effects that outweigh the benefits. Hence, other adjuvant therapies are mandatory to minimize the potential harm and ameliorate the quality of life. Herein, we summarize the current therapeutic strategies and introduce promising therapies for intractable autoimmune bullous diseases.
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Affiliation(s)
- Kuan-Yu Chu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
| | - Hsin-Su Yu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Sebastian Yu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Department of Dermatology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
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14
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Brazen B, Kidron A, Sheikh Z, Kamatgi V, Htoo S. Bullous Pemphigoid: A Spontaneous Presentation in a Patient With Chronic Kidney Disease. Cureus 2022; 14:e25806. [PMID: 35822137 PMCID: PMC9271213 DOI: 10.7759/cureus.25806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering pathology characterized by the development of pruritic, tense bullae and blisters on the lower extremities, axilla, and trunk. Its dermatopathology entails autoantibodies that target hemidesmosomes located in the basement membrane. The disease typically manifests in individuals over 50 years old with a higher prevalence in patients with concurrent neurological or dermatological autoimmune diseases. In this report, we discuss a case of a 67-year-old male who presented with a one-month history of itchy blisters occurring bilaterally in the lower extremities. The manifestation of BP, its pathophysiology, and treatment modalities are explored, We also engage in a review of the relevant literature.
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15
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Martora F, Picone V, Fabbrocini G, Megna M. How to decrease systemic corticosteroids in pemphigus patients under rituximab. Health Sci Rep 2022; 5:e639. [PMID: 35677471 PMCID: PMC9169508 DOI: 10.1002/hsr2.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Vincenzo Picone
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
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16
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Mozafari N, Ganji R, Toossi P. A rare new presentation of pemphigus vulgaris. Clin Case Rep 2022; 10:e5979. [PMID: 35769239 PMCID: PMC9210132 DOI: 10.1002/ccr3.5979] [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] [Received: 03/25/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
We report a new presentation for pemphigus vulgaris in a 51-year-old female patient that was complaining only from non-healing foot ulcer, but unfortunately pemphigus was not confirmed and the patient lost multiple nails. This new variation is reported to increase health workers' awareness especially in races pemphigus seems to be common.
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Affiliation(s)
- Nikoo Mozafari
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Raziyeh Ganji
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Parviz Toossi
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
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17
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Zhang Y, Lang X, Guo S, He H, Cui H. Bullous pemphigoid after inactivated COVID-19 vaccination: Case report. Dermatol Ther 2022; 35:e15595. [PMID: 35608483 PMCID: PMC9347905 DOI: 10.1111/dth.15595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/08/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yingjie Zhang
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.,The First Clinical Medical College of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Xiaoqing Lang
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Shuping Guo
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hongxia He
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hongzhou Cui
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
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18
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A Review of the Immunologic Pathways Involved in Bullous Pemphigoid and Novel Therapeutic Targets. J Clin Med 2022; 11:jcm11102856. [PMID: 35628982 PMCID: PMC9146139 DOI: 10.3390/jcm11102856] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Bullous pemphigoid (BP) is a rare, chronic antibody-mediated autoimmune blistering disease primarily affecting the elderly, with an age of onset over 60. Current treatment options are limited and involve the use of corticosteroids and immunosuppressants, but their long-term use is associated with significant morbidity and mortality. In Japan, human intravenous immunoglobin is approved for the treatment of corticosteroid-refractory BP. However, no treatment option is approved by the Food and Drug Administration for the management of BP. Therefore, developing effective therapies free of debilitating side effects is imperative. In this review, we summarize the main immunologic pathways involved in the pathogenesis of BP, with an emphasis on the role of eosinophils, immunoglobulins, cytokines such as the interleukin (IL)-4 and IL-5, and complements. We further discuss the latest advances with novel therapeutic targets tested for the management of BP. Ongoing efforts are needed to run well-designed controlled trials and test the efficacy and safety of investigational drugs while providing much-needed access to these medications for refractory patients who will not otherwise be able to afford them as off-label prescriptions.
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19
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Miše J, Jukić IL, Marinović B. Rituximab - Progress but Still Not a Final Resolution for Pemphigus Patients: Clinical Report From a Single Center Study. Front Immunol 2022; 13:884931. [PMID: 35592312 PMCID: PMC9110665 DOI: 10.3389/fimmu.2022.884931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Pemphigus is a rare autoimmune disease characterized by the production of pathogenic autoantibodies against desmosomal adhesion proteins, desmoglein 1 and 3. The pathophysiological process leads to the development of blisters and erosions on mucosal and/or skin surfaces as the main clinical manifestation of the disease. Rituximab emerged as the first-line therapeutic option for pemphigus due to its ability to induce remission by depleting peripheral B lymphocytes. Our aim was to assess the efficacy of rituximab in the treatment of patients in Croatia. A single-center, retrospective study was conducted on 19 patients treated with rituximab following a rheumatoid arthritis dosing protocol between October 2015 and March 2021, with a mean follow-up of 24.1 months. After the first rituximab cycle, two patients achieved complete remission off therapy (10.5%), and six patients achieved complete remission on minimal therapy (31.6%). Partial remission was observed among ten patients (52.6%). Eight patients (44.4%) relapsed after the first rituximab cycle. The mean relapse time was 21 months. Seven patients received two rituximab cycles, and three patients received three cycles. Overall, 13 out of 19 patients experienced complete remission at some point during the study, while there were no non-responders after the rituximab treatment. No statistically significant associations were observed between age, sex, type of disease involvement and clinical remission, either on or off therapy. A steady decrease in anti-desmoglein 1 and anti-desmoglein 3 levels was measured among all patients following rituximab treatment. One patient experienced a treatment-related adverse event of infectious etiology (cellulitis). One patient died following the first rituximab cycle, with the cause of death likely not to be associated with the treatment. Rituximab is an effective disease-modifying agent in the treatment of pemphigus with the main benefit of reducing corticosteroid exposure and steroid-related side effects among pemphigus patients. However, a feature of rituximab therapy is high relapse rates and the need for repeated treatment cycles to achieve complete remission. Developing an optimal protocol for rituximab treatment and finding suitable markers for predicting relapse will improve the management of pemphigus patients.
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Affiliation(s)
- Joško Miše
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ines Lakoš Jukić
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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20
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Gotera N, Weilg P, Heleno C, Ferrari-Gabilondo N. A Case of Bullous Pemphigoid Associated With Nivolumab Therapy. Cureus 2022; 14:e24804. [PMID: 35686260 PMCID: PMC9169882 DOI: 10.7759/cureus.24804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
This is a case report of new-onset bullous pemphigoid after the initiation of nivolumab for melanoma. Bullous pemphigoid is a rare immune-mediated adverse effect of nivolumab, with fewer than a hundred cases described. The patient initially developed a rash, which later progressed to respiratory symptoms, prompting the discontinuation of nivolumab. He was started on oral steroids, which improved his symptoms. However, while being tapered off the steroids, his rash reoccurred with the development of bullous pemphigoid. The diagnosis was confirmed by increased eosinophils and sub-epidermal vesicle formation compatible with bullous pemphigoid on skin biopsy. The patient was treated with steroids, mycophenolate, doxycycline, and niacinamide with significant improvement in his symptoms.
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Affiliation(s)
- Nico Gotera
- Internal Medicine, MercyOne North Iowa Medical Center, Mason City, USA
| | - Pablo Weilg
- Rheumatology, Boston University School of Medicine, Boston, USA
| | - Caio Heleno
- Internal Medicine, MercyOne North Iowa Medical Center, Mason City, USA
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21
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Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis. PLoS One 2022; 17:e0264705. [PMID: 35427358 PMCID: PMC9012347 DOI: 10.1371/journal.pone.0264705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/01/2022] [Indexed: 12/29/2022] Open
Abstract
Objective To systematically evaluate the prognostic factors for mortality in bullous pemphigoid. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc and Wanfang Database were searched to collect literature on the prognostic factors for mortality in bullous pemphigoid. The quality of studies was assessed by Newcastle–Ottawa Quality Assessment Scale. Two researchers extracted relevant data and scored study quality independently. The hazard ratio (HR) was calculated using the random effects model. Study heterogeneity was assessed using both Cochran’s Q test and I2 statistics. The causes of heterogeneity were assessed by subgroup analysis and/ or sensitivity analysis when heterogeneity was significant. When ten or more studies were included as outcome indicators, publication bias was evaluated by funnel plot and Egger’s test. Results Out of a total of 1,546 articles retrieved, 15 studies involving 2,435 patients were included. The meta-analysis showed that the mortality of patients with bullous pemphigoid increased with positive bullous pemphigoid 180 antibody (HR = 1.85, 95%CI: 1.25~2.75, P = 0.002); concomitant dementia (HR = 2.26, 95%CI: 1.43~3.59, P<0.001); stroke (HR = 2.09, 95% CI: 1.23–3.55, P = 0.007); heart disease (HR = 1.96, 95% CI: 1.41–2.73, P<0.001) and diabetes mellitus (HR = 2.39, 95% CI: 1.55–3.69, P<0.001). Sex, positive indirect immunofluorescence and hypertension were not associated with prognosis. Conclusion Positive bullous pemphigoid 180 antibody, dementia, stroke, heart disease and diabetes mellitus were the prognostic factors for mortality in bullous pemphigoid.
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22
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Comorbidities in Patients with Autoimmune Bullous Disorders: Hospital-Based Registry Study. Life (Basel) 2022; 12:life12040595. [PMID: 35455086 PMCID: PMC9031095 DOI: 10.3390/life12040595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/03/2022] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
Abstract
The incidence of autoimmune bullous disorders has increased over the years, especially in elderly patients with multiple comorbidities, which has stimulated research into their association with other diseases. We performed a retrospective observational study used the Minimum Basic Data Set of hospital discharges to review records of patients admitted to Spanish public hospitals between 2016 and 2019 with a diagnosis of any autoimmune bullous disorder. The objectives were to describe the comorbidity profile and the clinical-epidemiological characteristics of patients with pemphigus and pemphigoid, and analyze the evolution of the incidence of these diseases. The study included 1950 patients with pemphigus and 5424 patients with pemphigoid. Incidence increased from 2016 to 2019. The main comorbidities were hypertension (40.19%) and diabetes mellitus (28.57%). Compared to patients with pemphigoid, those with pemphigus had a higher prevalence of neoplasms, osteoporosis, solid metastases and malignant lymphoma, while the prevalence of hypertension, kidney disease, diabetes, heart failure, dementia, chronic obstructive pulmonary disease and Parkinson’s disease was higher in the pemphigoid group (p < 0.05). Therefore, since autoimmune bullous disorders are associated with diverse comorbidities and their incidence has risen in recent years, the establishment of strategies to prevent the main comorbidities in these patients is justified.
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23
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Somerville E, Gebauer K, Mclean‐Tooke A. Treatment of pemphigus in Australia: Aligning current practises with global recommendations. Australas J Dermatol 2022; 63:190-196. [DOI: 10.1111/ajd.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Kurt Gebauer
- University of Western Australia Crawley WA Australia
| | - Andrew Mclean‐Tooke
- Department of Clinical Immunology Sir Charles Gairdner Hospital Perth WA Australia
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24
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Ninković-Baroš Đ, Balaban J, Umićević-Šipka S, Gajanin V. Relationship between the age and sex of the patient with the results of the indirect immunofluorescence test in patients with bullous dermatoses. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-37483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background/Aim: Autoimmune bullous diseases are characterised by the production of autoantibodies to epidermal or subepidermal adhesive proteins. The aim of this study was to determine the relationship between age and sex of patients with the results of indirect immunofluorescence test in patients with newly diagnosed bullous dermatoses. Methods: The investigation presents a retrospective study of newly diagnosed patients with autoimmune bullous diseases at the Clinic for Skin and Venereal Diseases of the University Clinical Centre in Banja Luka in the period 2016-2021. In addition to demographic data, the results of an indirect immunofluorescence test in two titres (≥ 1:10 and ≥ 1:100) were analysed. Results: In this study, almost the same number of patients with pemphigus (45.2 %) and pemphigoid (54.8 %) was found. There were more women than men in the total sample (p = 0.049). The average age of subjects with pemphigoid was higher than that of patients with pemphigus (p = 0.001). 48.2 % of patients with pemphigus and 51.8 % of patients with pemphigoid had a positive indirect immunofluorescence test. A positive test for epidermal intercellular substance in both sexes at a titre ≥ 1:100 is higher than a titre ≥ 1:10 (p = 0.029). Patients with autoantibody titres ≥ 1:100 to desmoglein-1 were statistically significantly older than patients with titres ≥ 1:10 (p = 0.047). Conclusion: Number of patients with pemphigus and pemphigoid were similar, with no difference in sex distribution between the two groups of patients, but patients with pemphigoid were older than patients with pemphigus. The difference between high and low autoantibody titres in both sexes was found only in the group of pemphigus on epidermal intercellular substance and desmoglein-1.
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25
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Malik AM, Tupchong S, Huang S, Are A, Hsu S, Motaparthi K. An Updated Review of Pemphigus Diseases. Medicina (B Aires) 2021; 57:medicina57101080. [PMID: 34684117 PMCID: PMC8540565 DOI: 10.3390/medicina57101080] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/19/2023] Open
Abstract
Clinicians may encounter a variety of skin conditions that present with vesiculobullous lesions in their everyday practice. Pemphigus vulgaris, pemphigus foliaceus, IgA pemphigus, and paraneoplastic pemphigus represent the spectrum of autoimmune bullous dermatoses of the pemphigus family. The pemphigus family of diseases is characterized by significant morbidity and mortality. Considering the risks associated with a delayed diagnosis or misdiagnosis and the potential for overlap in clinical features and treatment, evaluation for suspected pemphigus disease often requires thorough clinical assessment and laboratory testing. Diagnosis is focused on individual biopsies for histopathology and direct immunofluorescence. Additional laboratory methods used for diagnosis include indirect immunofluorescence and enzyme-linked immunosorbent assay. Recent advancements, including anti-CD20 therapy, have improved the efficacy and reduced the morbidity of pemphigus treatment. This contribution presents updates on the pathophysiology, clinical features, diagnostic work-up, and medical management of pemphigus. Improved strategies for diagnosis and clinical assessment are reviewed, and newer treatment options are discussed.
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Affiliation(s)
- Ali M. Malik
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (A.M.M.); (A.A.)
| | - Sarah Tupchong
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA;
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Abhirup Are
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (A.M.M.); (A.A.)
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Kiran Motaparthi
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL 32606, USA
- Correspondence:
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26
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Zeng FAP, Murrell DF. State-of-the-art review of human autoimmune blistering diseases (AIBD). Vet Dermatol 2021; 32:524-e145. [PMID: 34351020 DOI: 10.1111/vde.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
Autoimmune blistering diseases (AIBDs) are a heterogenous group of skin conditions, broadly classified into two categories depending on the location of blister formation: intraepidermal blistering in the pemphigus group and subepidermal blistering in the pemphigoid group. Although AIBDs occur in both humans and animals, the arsenal of data for human AIBDs far exceeds those of their animal counterpart. Therefore, the main purpose of this review is to highlight existing knowledge, and recent advances in the diagnosis and management of AIBDs in humans - to serve as a road map for veterinary dermatologists. AREAS COVERED: Recent findings include complement-independent pathways in the pathogenesis of bullous pemphigoid, as well as the role of desmoglein and desmocollin autoantibodies in inducing acantholysis. Systemic glucocorticoids are the mainstay of treatment for AIBDs in humans, yet their long-term use is associated with severe adverse effects and complications, thereby limiting their use. Therefore, researchers have been exploring new and safer alternative therapeutic options for human AIBDs such as anti-CD20 monoclonal antibodies (Rituximab), Bruton's tyrosine kinase inhibitors (BTKi) and neonatal Fc receptor (FcRn) blockers. EXPERT OPINION: Randomised controlled trial (RCT) level evidence show that Rituximab and short-course GC regimes are more effective and safer than traditional GC treatment for human AIBDs. FcRn blockers such as SYNT001 have shown positive results in preliminary phase 2 clinical trials for treatment of human pemphigus; further trials are required. Rilzabrutinib (PRN1008), an orally administered BTKi, has recently completed phase 2 trials in pemphigus and is in a phase 3 RCT in humans.
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Affiliation(s)
| | - Dedee F Murrell
- University of New South Wales, Sydney, Australia.,Department of Dermatology, St George Hospital, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
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27
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Gutierrez Y, Pourali SP, Singh I, Armstrong AW. Pemphigus and bullous pemphigoid in the United States: a 21-year analysis of patient characteristics, treatment patterns, and comorbidities. J DERMATOL TREAT 2021; 33:2383-2385. [PMID: 33769922 DOI: 10.1080/09546634.2021.1908944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yasmin Gutierrez
- University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Sarah P Pourali
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Indira Singh
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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28
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Petruzzi M, Lucchese A, Contaldo M, Tampoia M, Frassanito MA, Lauritano D, Della Vella F. ELISA detection of anti-desmoglein 1 and anti-desmoglein 3 and indirect immunofluorescence in oral pemphigus: A retrospective study. Oral Dis 2021; 28:1149-1156. [PMID: 33721369 DOI: 10.1111/odi.13849] [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: 11/24/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of autoantibodies to desmoglein 1 and desmoglein 3 detected by ELISA and indirect immunofluorescence in the diagnosis of oral pemphigus and to correlate the antibody titres with the severity of the disease. MATERIALS AND METHODS We report a retrospective cohort study of 22 patients with oral pemphigus and 64 controls from a single tertiary centre. Data about histopathological examination, direct immunofluorescence, indirect immunofluorescence and ELISA were analysed. Global validation of ELISA and IIF both alone and combined was established by calculating sensitivity, specificity, accuracy and both positive predictive value and negative predictive value. The relationship between Oral Disease Severity Score values and ELISA titres was analysed using Pearson's coefficient. RESULTS The best diagnostic performance was observed for anti-desmoglein 3 ELISA. The sensitivity was 75% and specificity 100% and positive predictive value and negative predictive value were 92.5% and accuracy 93.9%. The level of agreement with histopathology + direct immunofluorescence was substantial (k = .758). Anti-desmoglein 3 titres showed a significant correlation with Oral Disease Severity Score (p < .05). CONCLUSIONS Serological tests are commonly employed during clinical practice as adjunctive tools. Anti-desmoglein 3 ELISA should be considered as a first-instance diagnostic test for oral pemphigus early detection.
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical, Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical, Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Marilina Tampoia
- Section of Clinical Pathology, Policlinico Hospital, Bari, Italy
| | | | - Dorina Lauritano
- Department of Medicine and Surgery, Center of Neuroscience Milan, University of "Milan Bicocca", Monza, Italy
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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29
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Mahesh S, Kozymenko T, Kolomiiets N, Vithoulkas G. Antimonium crudum in pediatric skin conditions: A classical homeopathic case series. Clin Case Rep 2021; 9:818-824. [PMID: 33598251 PMCID: PMC7869354 DOI: 10.1002/ccr3.3674] [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] [Received: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Homeopathic Antimonium crudum may be useful in many pediatric skin conditions if prescribed on symptom similarity. It may especially be helpful in reducing the use of antibiotics and steroids in this age-group if proven to be effective through larger scientific studies.
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Affiliation(s)
- Seema Mahesh
- School of MedicineFaculty of Health and Medical SciencesTaylor’s UniversitySelangorMalaysia
| | - Tamara Kozymenko
- Private Higher Educational EstablishmentKyiv Medical UniversityKyivUkraine
| | | | - George Vithoulkas
- Postgraduate Doctors’ Training InstituteHealth Care Ministry of the Chuvash RepublicCheboksaryRussia
- International Academy of Classical HomeopathyAlonissosGreece
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30
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Wang YN, Hammers CM, Mao X, Jin HZ, Yuan J, Li L. Analysis of the autoimmune response against BP180 in patients with Alzheimer's disease. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:107. [PMID: 33569409 PMCID: PMC7867912 DOI: 10.21037/atm-20-5343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Current epidemiological studies suggest a significant correlation between Alzheimer's disease (AD) and bullous pemphigoid (BP). However, the autoimmune response against BP180 in patients with AD has not been fully understood. investigated. Methods We randomly enrolled 48 patients with AD and 50 sex- and age-matched healthy controls. We detected the presence/absence and the level of anti-BP180/BP230 immunoglobulin G (IgG) autoantibodies in the patients' serum to determine whether said antibodies possess reactivity against the BP180 protein in the human brain and skin. Results The enzyme-linked immunosorbent assay (ELISA) results revealed that the positive rate of anti-BP180 autoantibodies in patients with AD (23/48, 47.9%) was significantly higher than that in controls (4/50, 8.0%; P<0.0001). These ELISA-positive patients were further examined through immunoblotting. Sera from nine patients with AD (9/23, 39.1%) and one control (1/4, 25.0%) reacted with human cutaneous recombinant full-length BP180 and BP180-noncollagenous 16A (NC16A). Sera from 11 (11/23, 47.8%) patients with AD reacted with a 180-kDa protein from the human brain extract, but none of the controls' sera recognized the corresponding protein band. The majority of the patients in the anti-BP180-positive AD group were men (14/23, 60.9%) who were older (74.0 years) compared with those in the control group (6/25, 24.0%; P<0.05) (72.2 years; P<0.01). Conclusions Anti-BP180 autoantibodies are present in AD and recognize human recombinant full-length BP180 and a 180-kDa protein from the human brain extract, suggesting that BP180 is a shared autoantigen in AD and BP and may help clarify the mechanism to explain why a high risk of BP exists in AD. Elderly male patients with AD are significantly more likely to develop BP180 serum autoreactivity compared with other patients with AD.
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Affiliation(s)
- Ya-Nan Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Xuming Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hong-Zhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Watson N, Carrozzo M, Hampton P. A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease. J Oral Pathol Med 2020; 50:92-97. [PMID: 33184901 DOI: 10.1111/jop.13123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autoimmune bullous disorders, encompassing pemphigus and pemphigoid diseases, are associated with significant morbidity and mortality. This is in part due to high cumulative doses of corticosteroids in combination with immunosuppressant agents used in traditional treatment regimes. Rituximab is an antiCD20 monoclonal antibody which can induce complete remission, but it is currently unlicensed in the UK and approved only after other treatments have failed. METHODS We report a retrospective cohort study of 33 patients with pemphigus and pemphigoid diseases treated with rituximab from a single tertiary centre from 2013 to 2019. RESULTS "Complete remission off therapy" was achieved by 27.3% (n = 9), and a further 27.3% (n = 9) had complete remission on minimal therapy. Twenty-one per cent (n = 7) had "partial remission on minimal therapy"; 9.1% (n = 3) patients were in the "consolidation phase," and 12.1% (n = 4) had a "relapse/flare." A steady reduction in prednisolone doses was observed post-Rituximab infusion. Pre-Rituximab the median dose of prednisolone was 20mg (range 10-35, IQR 25), 15mg (range 9.5-22.5, IQR 13) at 1 month, 9mg (range 5-10, IQR 5) at 6 months, 4mg (range 0-5mg, IQR 5) at 12 months and 0 (0-4.35, IQR 4.25) at 18 months. Twelve per cent (n = 4) of patients had documented infusion reaction symptoms. Twelve per cent (n = 4) had later infective complications. CONCLUSION This real clinic data adds to the evidence that Rituximab is a safe and effective treatment for both pemphigus and pemphigoid autoimmune blistering conditions. Significantly, we were able to demonstrate a substantial reduction in corticosteroid dosage in our cohort of patients following rituximab treatment.
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Affiliation(s)
- Nicola Watson
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Marco Carrozzo
- School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Philip Hampton
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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