1
|
Tan AJ, Archila M, Barbieri JS, Mostaghimi A, Scherer AM, Perez-Chada LM, Asgari MM, Gelfand JM, Noe MH. Understanding patient perspectives on vaccine decision making in adults with autoimmune bullous diseases: a qualitative study. Arch Dermatol Res 2024; 316:125. [PMID: 38637431 DOI: 10.1007/s00403-024-02862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/22/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Patients with autoimmune bullous diseases are at an increased risk of infection, both from the underlying skin disease and from immunosuppressive treatments. Limited information is available on vaccine beliefs and behaviors in dermatology patients and adults with autoimmune bullous diseases in particular. To understand vaccine decision making, identify perceived risks and benefits of vaccinations, and discuss individual experiences in patients with autoimmune bullous diseases in the United States. A qualitative study was performed utilizing semi-structured interviews, and analysis was conducted on NVivo. Patterns were identified in the coded data, and representative quotations were recorded for each major theme. Interviews were conducted between February 15, 2022 and September 15, 2022. Twenty patients with a diagnosis of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, or pemphigus foliaceous were interviewed. Of the 20 participants, 14 (70%) were female, with a mean (SD, range) age of 64.8 (13.2, 34-83) years. Key themes that emerged from qualitative analysis of the interviews included patient concerns regarding their increased susceptibility to infection, potential exacerbation of skin disease following vaccination, and the effect of immunosuppressive medications on humoral response to vaccines. Lack of appointment availability, difficulty accessing vaccines, and cost were commonly identified barriers to vaccination. These findings provide valuable knowledge for dermatologists in regard to providing counseling specific to patient concerns and to improve communication surrounding vaccination in the dermatology setting.
Collapse
Affiliation(s)
- Alice J Tan
- University of Massachusetts Medical School, Worcester, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Marjorie Archila
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02215, USA.
| |
Collapse
|
2
|
Noble CA, Bhate C, Duong BT, Cruse AR, Brodell RT, Hanus RC. Clinical-pathologic correlation: The impact of grossing at the bedside. Semin Diagn Pathol 2024:S0740-2570(24)00006-6. [PMID: 38336505 DOI: 10.1053/j.semdp.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/02/2024] [Indexed: 02/12/2024]
Abstract
The unenlightened clinician may submit a skin specimen to the lab and expect an "answer." The experienced clinician knows that in performing skin biopsies, it is critical to select the most appropriate: 1) anatomic location for the biopsy1,2; 2) type of biopsy1,2; 3) depth and breadth of the biopsy; and 4) medium for hematoxylin and eosin staining (formalin) or direct immunofluorescence (Michel's Transport Medium or normal saline).2 Demographic information, anatomic location, clinical context, and differential diagnosis are all critical components of a properly completed requisition form.3-5 Proper biopsy design and appropriate grossing of the tissue at the bedside should be added to this list. In this article, we review the basics of gross pathologic examination and then provide four examples to demonstrate that optimal clinical-pathologic correlation requires the clinician consider the needs of the pathologist when tissue is presented to the lab.
Collapse
Affiliation(s)
- C Alexis Noble
- PGY-3, Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Chinmoy Bhate
- Clinical Assistant Professor, Dermatology, Pathology & Laboratory Medicine Rutgers New Jersey Medical School Newark, New Jersey, United States
| | - Buu T Duong
- University of Mississippi Medical Center Jackson, Mississippi, United States
| | - Allison R Cruse
- Assistant Professor, Department of Dermatology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Robert T Brodell
- Professor and Chair, Department of Dermatology, Professor, Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Riley C Hanus
- Department of Mechanical Engineering, Georgia Institute of Technology Atlanta, GA, United States
| |
Collapse
|
3
|
Xie Z, Gao Y, Tian L, Jiang Y, Zhang H, Su Y. Pemphigus and pemphigoid are associated with Alzheimer's disease in older adults: evidence from the US Nationwide inpatient sample 2016-2018. BMC Geriatr 2023; 23:872. [PMID: 38114905 PMCID: PMC10731856 DOI: 10.1186/s12877-023-04580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Pemphigus and pemphigoid are rare autoimmune skin disorders caused by autoantibodies against structural proteins and characterized by blistering of the skin and/or mucous membranes. Associations have been noted between skin diseases and Alzheimer's dementia (AD). Dementia is a neurological disorder of progressive cognitive impairment with increasing incidence among older adults. This study aimed to assess the potential associations between pemphigus, pemphigoid and AD in a large, nationally representative US cohort. METHODS All data of hospitalized patients aged 60 years or older were extracted from the US Nationwide Inpatient Sample (NIS) database 2016-2018. Patients with a history of head trauma, diagnosis of vascular dementia, history of cerebrovascular disease, or malformation of cerebral vessels were excluded. The study population was divided into those with and without pemphigus (cohort 1) and with and without pemphigoid (cohort 2). RESULTS Pemphigus was independently associated with a 69% increased risk of AD. Adults ≥80 years old with pemphigus were 72% more likely to develop AD than adults without pemphigus. Women with pemphigus were 78% more likely to develop AD than women without pemphigus. On the other hand, pemphigoid was independently associated with a 39% increased risk for AD and subjects ≥80 years with pemphigoid were 40% more likely to have AD than those without pemphigoid. Females with pemphigoid were 63% more likely to have AD than those without pemphigoid. Moreover, Hispanic older adults with pemphigus were 3-times more likely to have AD than those without pemphigoid. CONCLUSIONS Pemphigus and pemphigoid were both independently associated with AD in older adults, especially among females and octogenarians. Further studies addressing the etiology and mechanisms underlying these associations are highly warranted.
Collapse
Affiliation(s)
- Zhen Xie
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Gao
- General Practice Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lidi Tian
- Department of Dermatology, Ya'an People's Hospital, 358 Chenghou Road, Yucheng District, Ya'an, China
| | - Yang Jiang
- Department of Dermatology, Baoan Central Hospital of Shenzhen, 518001, No.6 Xinyuan Street, Xixiang Road, Shenzhen, 518001, China
| | - Hao Zhang
- Department of Dermatology, Baoan Central Hospital of Shenzhen, 518001, No.6 Xinyuan Street, Xixiang Road, Shenzhen, 518001, China.
| | - Yang Su
- Department of Laboratory Medicine and Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| |
Collapse
|
4
|
Zhou S, Zhang Q, Deng Y, Shen Z, Liu W. Pemphigus and pemphigoid research by dermatologists and stomatologists: A scientometric and comparative study. J Dent Sci 2023; 18:1510-1516. [PMID: 37799900 PMCID: PMC10547994 DOI: 10.1016/j.jds.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/12/2023] [Indexed: 10/07/2023] Open
Abstract
Background/purpose Pemphigus and pemphigoid are systemic bullous autoimmune diseases affecting skin and/or mucosal membranes with the life-threatening nature, especially pemphigus vulgaris. The papers published by dermatologists and stomatologists preferentially represent their concerns of a mucocutaneous disease. Materials and methods The objective of this study was to compare the scientometric characteristics of pemphigus and pemphigoid publications by dermatologists and stomatologists in the Scopus database. Results There are 9276 and 760 papers published by dermatologists and stomatologists, respectively. The annual number of the publications by dermatologists stably raised from 218 to 526 during 2007-2022; while the number by stomatologists raised with a small amount from 18 to 51 during this period. For the most-cited top-200 papers, the total citation count is 42,766 and the h index is 148 for pemphigus publications by dermatologists; whereas the count is 14,689 and h index is 63 for publications by stomatologists. Notably, first signs of pemphigus often appear in oral mucosa, manifesting as erythema, blisters, as well as mouth ulcer, gingivitis, lichen planus-like pemphigus. Conclusion This study firstly reports the scientometric characteristics of pemphigus publications by dermatologists and stomatologists. The scale and citations of dermatologists' publications greatly outweigh stomatologists' ones, suggesting stomatologists can learn from and more cooperate with dermatologists regarding pemphigus research.
Collapse
Affiliation(s)
- Shanxin Zhou
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Qianqian Zhang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiwen Deng
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhengyu Shen
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Liu
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| |
Collapse
|
5
|
Kasperkiewicz M, Woodley DT. COVID-19 and autoimmune bullous diseases: Lessons learned. Autoimmun Rev 2023; 22:103286. [PMID: 36738951 PMCID: PMC9893837 DOI: 10.1016/j.autrev.2023.103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Both COVID-19 and autoimmune bullous diseases represent potentially life-threatening conditions. Autoimmunity has been a special focus during the COVID-19 pandemic considering the possible detrimental mutual influence between COVID-19 and autoimmune disorders as well as their supposed induction or triggering by SARS-CoV-2 vaccines. There is a growing need to assess the impact of the current pandemic particularly in patients with autoimmune bullous diseases requiring potent and long-term immunosuppressive treatments. This review provides the relevant state-of-the-art knowledge, including our own research, about immunobullous diseases in relation to COVID-19 and summarizes expert perspectives on their management throughout the pandemic.
Collapse
Affiliation(s)
- Michael Kasperkiewicz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - David T Woodley
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
6
|
Holtsche MM, Boch K, Schmidt E. Bullöse Autoimmundermatosen. J Dtsch Dermatol Ges 2023; 21:405-413. [PMID: 37070505 DOI: 10.1111/ddg.15046_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Maike M Holtsche
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinik Schleswig-Holstein, Campus Lübeck
| | - Katharina Boch
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinik Schleswig-Holstein, Campus Lübeck
| | - Enno Schmidt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinik Schleswig-Holstein, Campus Lübeck
- Lübecker Institut für Experimentelle Dermatologie, Universität Lübeck
| |
Collapse
|
7
|
Holtsche MM, Boch K, Schmidt E. Autoimmune bullous dermatoses. J Dtsch Dermatol Ges 2023; 21:405-412. [PMID: 37070500 DOI: 10.1111/ddg.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 04/19/2023]
Abstract
Autoimmune bullous dermatoses (AIBD) are a heterogeneous group of about a dozen diseases characterized clinically by erosions and blisters and immunopathologically by autoantibodies against structural proteins of the skin or transglutaminase 2/3. The diagnosis of AIBD has made tremendous progress in the last decade due to the availability of standardized serological assays that, knowing the clinical picture, allow the diagnosis in the vast majority of patients. The development of various in vitro and in vivo models of the most common AIBD, namely, bullous pemphigoid, pemphigus vulgaris, mucous membrane pemphigoid, and the rare epidermolysis bullosa acquisita, allows identification of key molecules and inflammatory pathways as well as preclinical evaluation of the effect of new anti-inflammatory agents. The approval of rituximab for moderate and severe pemphigus vulgaris and the development of national and international guidelines for the most common AIBD have considerably advanced the care of these patients. Nevertheless, the limited therapeutic armamentarium is the main challenge for the management of AIBD. Several phase II and III randomized controlled clinical trials provide hope for new, effective, and safe therapeutic options in the coming years. This review summarizes the epidemiology, clinic, diagnosis, pathophysiology, and therapy of AIBD and gives an outlook on both current diagnostic and therapeutic needs as well as future developments.
Collapse
Affiliation(s)
- Maike M Holtsche
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Lübeck Institute for Experimental Dermatology, University of Lübeck, Germany
| |
Collapse
|
8
|
Bizikova P, Olivry T, Linder K, Rybnicek J. Spontaneous autoimmune subepidermal blistering diseases in animals: a comprehensive review. BMC Vet Res 2023; 19:55. [PMID: 36849885 PMCID: PMC9969658 DOI: 10.1186/s12917-023-03597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
Autoimmune subepidermal blistering diseases (AISBDs) are rare skin disorders of animals that were first identified in dogs but several AISBDs are now recognised in other companion animal species. Most AISBDs in animals are homologues of the human diseases and are thought to share similar pathomechanisms of epidermal and/or mucosal blister formation caused by autoantibodies targeting structural proteins of the basement membrane zone (BMZ). Disruption of their structural function by the autoantibodies and/or recruited inflammation leads to BMZ fragility, which presents clinically as vesicles, bullae and, later, deep erosions and ulcers. Canine AISBDs are the best characterised, particularly the more common variants such as mucous membrane pemphigoid (48%), epidermolysis bullosa acquisita (EBA) (26%), and bullous pemphigoid (10%). Exceedingly rare AISBDs in the dog are junctional EBA, mixed AISBD, type-1 bullous systemic lupus erythematosus, linear IgA dermatosis, and pemphigus gestationis. The diagnosis of a specific AISBD is made by combining the clinical features (breed, age, lesion distribution) with histological evidence of subepithelial clefting, but not all AISBDs can be differentiated in this manner and specialised immunological testing is required. This latter, unfortunately, is not readily available and, therefore, the specific AISBD diagnosis often remains unconfirmed. While this limits further understanding of these diseases, it does not prevent clinicians from treating their patients, as the treatment approaches are similar for the different AISBDs in dogs. This review primarily focuses on canine AISBDs, the species for which these diseases have been best characterised, and shorter descriptions of variants in other species are also provided.
Collapse
Affiliation(s)
- Petra Bizikova
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Thierry Olivry
- grid.40803.3f0000 0001 2173 6074Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Keith Linder
- grid.40803.3f0000 0001 2173 6074Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Jan Rybnicek
- Veterinary Dermatology and Dermatopathology Service, Padochov 175, 66491 Ivancice, Czech Republic
| |
Collapse
|
9
|
Koh XQ, Tan KB, Schmidt E, Zillikens D, Chandran NS. Case Report of a Novel Association between Anti-p200 Pemphigoid and Acquired Haemophilia A. Ann Dermatol 2023; 35:61-65. [PMID: 36750460 PMCID: PMC9905869 DOI: 10.5021/ad.20.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/31/2023] Open
Abstract
Anti-p200 pemphigoid is an uncommon subepidermal autoimmune bullous disease that, unlike many other autoimmune bullous diseases, has not previously been associated with hematological diseases. The diagnosis of anti-p200 pemphigoid in a patient with congruent clinical features requires the demonstration of subepidermal blistering, with linear deposition of immunoglobulin (Ig) G and/or C3 at the dermoepidermal junction on direct immunofluorescence, and a floor-binding pattern on indirect immunofluorescence. In addition, the detection of antibodies against p200 antigen via immunoblotting is ideal but not readily accessible in many facilities, leading to a potential under-recognition and under-diagnosis of this condition. In this case report, we describe a 53-year-old gentleman with recently diagnosed acquired hemophilia A who developed a concurrent vesiculobullous eruption and was evaluated to have anti-p200 pemphigoid. Both of his conditions were controlled with immunosuppression via prednisolone and cyclophosphamide. While we acknowledge the contemporaneous occurrence of both diseases in this patient may be a mere coincidence, it is important to recognize the possibility of this association given the potential clinical significance. Whether the activity of one disease parallels the other will require further evaluation.
Collapse
Affiliation(s)
- Xuan Qi Koh
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - Kong Bing Tan
- Department of Pathology, National University Hospital, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Enno Schmidt
- Department of Dermatology and Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
10
|
Hübner S, Sarhan M, Schauer F. Use of Complementary and Alternative Medicine in Patients with Autoimmune Bullous Dermatoses: A Cohort Study Analysis of a Rare Disease Group. Complement Med Res 2023; 30:221-229. [PMID: 36646063 DOI: 10.1159/000529142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Autoimmune bullous diseases (AIBD) are a heterogeneous group of rare autoantibody-mediated blistering dermatoses of the skin and/or mucous membranes. Their incidence is around 20 new cases per million inhabitants per year in Germany. Patients with chronic, oncological, or rare diseases often urge for a holistic therapeutic approach that includes complementary and alternative medicine (CAM). So far, only few contradictory reports on CAM in pemphigoid or pemphigus disease exist. The purpose of this study was to determine the frequency, motives, and satisfaction with the use of alternative treatments in patients with AIBD and to provide a basis for further investigation. METHODS We used a structured online questionnaire, consisting of 20 questions to survey patients with AIBD and their relatives. The German pemphigus and pemphigoid self-help groups were responsible for distributing anonymized questionnaires. In total, we recovered 97 questionnaires, 63 of which met full inclusion criteria (24 males and 39 females). RESULTS Of the included participants, more than half had a currently active disease. Of all patients, 58.7% stated that they had used CAM at least once. Women were more likely to use CAM, whereas age and education showed no association to CAM use. The main motives for using CAM were "doing something for oneself" and "opportunity to contribute to treatment" (38.1% each). The internet (23.8%) was the most common source of information, and vitamins were the most frequently used therapy (49.2%). CONCLUSION Our results provide new insights into the demand for CAM within this rare disease patient group. Physicians should be aware of these methods to meet patient needs but also be able to identify potential barriers such as risks and interactions.
Collapse
Affiliation(s)
- Stefanie Hübner
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Maysa Sarhan
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
| |
Collapse
|
11
|
Fujita N, Yamashita T, Abe F, Nara M, Yoshioka T, Koga H, Ishii N, Takahashi N. [Refractory esophageal stricture of esophageal mucous membrane pemphigoid after allogeneic hematopoietic stem cell transplantation]. Rinsho Ketsueki 2023; 64:107-112. [PMID: 36990729 DOI: 10.11406/rinketsu.64.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Haploidentical allogeneic hematopoietic stem cell transplantation from her brother was performed on a 41-year-old lady with no prior history of pemphigoid to treat recurrent AML. On day 59 following transplantation, she experienced esophageal stenosis. During immunosuppressive therapy for graft vs. host disease, this condition was controlled with periodic esophageal dilatation (GVHD). Her esophageal stricture, which required periodic dilatation, grew worse after she stopped immunosuppressive therapy because of recurrent AML. The esophageal mucosa was easily hemorrhagic and desquamative. Histologic analysis revealed that the squamous cell layers had been divided. Indirect immunofluorescence was negative for IgG and positive for IgA on the epidermal layers, while direct immunofluorescence showed a linear deposition of IgG on the basement membrane zone. It was determined through immunoblotting utilizing recombinant protein of BP180 C-terminal domain that both IgG and IgA antibodies were present, supporting the diagnosis of mucous membrane pemphigoid with anti-BP180. After allogeneic transplantation, basal epidermal cell destruction by GVHD may result in autoimmune blistering disorders, which expose basement membrane proteins and antigen presentation. A similar mechanism could apply to our situation. For rare GVHD cases, a thorough histological diagnosis is required.
Collapse
Affiliation(s)
- Nanako Fujita
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine
| | - Takaya Yamashita
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine
| | - Fumito Abe
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine
| | - Miho Nara
- Division of Blood Transfusion, Akita University Hospital
| | - Tomoko Yoshioka
- Department of Hematology and Nephrology, Akita City Hospital
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine
| |
Collapse
|
12
|
De-Kaa NLP, Adefemi SA, Akuhwa RT, Fikin A, Atabo A. Bullous Pemphigoid Masquerading as Erythrodermic Psoriasis. West Afr J Med 2022; 39:1319-23. [PMID: 36583972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bullous Pemphigoid occurs more commonly in the elderly with a rare occurrence in infancy, childhood and adolescence. The uniqueness of this presentation in the adolescents warrants this report. Both Erythrodermic Psoriasis and Bullous Pemphigoid are autoimmune skin disorders that differ in presentation though some of the symptoms may overlap. While Erythrodermic Psoriasis presents with massive scaling, Bullous Pemphigoid presents with vesiculo-bullous lesions and blisters which heal and keep spreading leaving burn-like areas. Bullous Pemphigoid is the most frequent subepidermal autoimmune bullous skin disease and could have a polymorphic presentation. At presentation there was massive scaling with intense itching however in the course of treatment, vesicles, blisters and bullae became apparent and the histology result was consistent with the diagnosis of Bullous Pemphigoid. Bullous Pemphigoid was therefore masquerading as Erythrodermic Psoriasis.
Collapse
|
13
|
Lütgerath C, Sadik CD, van Beek N. [Trigger factors associated with bullous autoimmune dermatoses]. Dermatologie (Heidelb) 2022; 74:948-954. [PMID: 37943295 DOI: 10.1007/s00105-023-05249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Blistering autoimmune dermatoses are a heterogeneous group of rare diseases. Pemphigus diseases are distinguished from pemphigoid diseases as well as dermatitis herpetiformis. In pemphigus diseases, cutaneous blistering is caused by an intraepidermal loss of adhesion between keratinocytes. In pemphigoid diseases, blister formation is due to a subepidermal loss of adhesion of keratinocytes from the basement membrane. OBJECTIVES This article reviews the most important trigger factors associated with bullous autoimmune dermatoses and discusses their role in their initial manifestation as well as exacerbation. MATERIALS AND METHODS A focused review of the literature including original articles, guidelines, reference works and previously published review articles was performed. RESULTS Vaccinations, viral infections, ultraviolet light (UV) exposure and radiation therapies are possible triggers of pemphigus vulgaris in predisposed patients. For the much rarer pemphigus foliaceus, UV exposure is of particular importance. Thiols and phenols are drugs that can induce pemphigus usually resembling pemphigus foliaceus clinically. Age is the most important risk factor of bullous pemphigoid. In addition, in bullous pemphigoid associations with dipeptidyl peptidase 4 inhibitors, programmed cell death protein‑1 or programmed death-ligand‑1 inhibitors as well as neurological diseases are particularly relevant. Severe mucosal damage, certain drugs and in particular cases neoplasms might play a role in mucous membrane pemphigoid. CONCLUSION Knowing possible trigger factors facilitates a timely diagnosis upon initial manifestation and supports the prevention of relapse of bullous autoimmune dermatoses.
Collapse
Affiliation(s)
- Constantin Lütgerath
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Christian D Sadik
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Center for Research on Inflammation of the Skin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Nina van Beek
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| |
Collapse
|
14
|
Tan WH, Sim J, Sultana R, Lee HY. Rituximab in Subepidermal Blistering Diseases. Dermatology 2022; 239:5-11. [PMID: 36302346 DOI: 10.1159/000526600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although rituximab is known to be effective in the treatment of pemphigus, its role in subepidermal autoimmune blistering diseases is unclear and currently limited to off-label use. SUMMARY This is a meta-analysis of case reports, case series, and retrospective studies on the effectiveness and safety of rituximab in bullous pemphigoid, mucous membrane pemphigoid, ocular pemphigoid, and epidermolysis bullosa acquisita. We compared remission and relapse rates in patients who received rituximab with those who only received conventional medical therapy. Comparisons were also made among disease subgroups. KEY MESSAGE The present analysis suggests that patients with subepidermal autoimmune blistering diseases treated with rituximab achieve a higher rate of complete remission and encounter their first relapse after a longer time interval. However, time to remission and total relapse rates were similar between groups. Adverse events and mortality rates were no more common in patients who received rituximab. This analysis was limited by the absence of randomized controlled trials and the observation that rituximab was used as a late rescue therapy in most reports. In conclusion, rituximab may be effective in subepidermal blistering disease, but randomized controlled studies are required for the validation of current observational data.
Collapse
Affiliation(s)
- Wen Hao Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore,
| | - Jingwei Sim
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
15
|
Abstract
Autoimmune bullous diseases (AIBD) comprise a group of organ-specific autoimmune diseases which are characterised by the production of autoantibodies against adhesion molecules and structural proteins of skin and mucosae. Depending on the target protein, AIBD are classified into intraepidermal (pemphigus group) and subepidermal (pemphigoid group, epidermolysis bullosa acquisita, dermatitis herpetiformis) blistering disorders. Depending on the clinical entity, patients can develop blisters, pustules, erosions, and erythema on the skin and mucosae.
Collapse
Affiliation(s)
- Dario Didona
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland.
| | - Julia Hinterseher
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Rüdiger Eming
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland
- Klinik III Dermatologie, Venerologie und Allergologie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| |
Collapse
|
16
|
Kalantari Y, Sadeghi S, Asadi D, Goodarzi A. A literature review on Janus kinase (JAK) inhibitors for the treatment of immunobullous disorders. Int Immunopharmacol 2022; 110:108923. [PMID: 35717838 DOI: 10.1016/j.intimp.2022.108923] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/01/2023]
Abstract
Janus kinases (JAKs) are a group of intracytoplasmic tyrosine kinase proteins that bind to the cytoplasmic part of the transmembrane cytokine receptors and regulate signaling. The pathophysiology of various autoimmune and autoinflammatory conditions relies on JAK/STAT signaling and therefore, the inhibition of JAK/STAT pathways can be a promising treatment for such diseases, especially inflammatory skin conditions. The current study aimed to evaluate the efficacy of JAK inhibitors in the treatment of immunobullous diseases, including pemphigus, pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa. The databases used to identify the studies were Web of Science, Scopus, and PubMed/Medline for studies published until 2/3/2022. The current review suggests that JAK inhibitors may be revolutionary for the future treatments of dermatologic conditions, especially autoimmune bullous disease. Results also indicated the effectiveness of JAK inhibitors for the treatment of immunobullous diseases.
Collapse
Affiliation(s)
- Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- Department of Pediatrics, Division of Dermatology, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Delaram Asadi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Seirafianpour F, Pourriyahi H, Mesgarha MG, Pour Mohammad A, Shaka Z, Goodarzi A. A systematic review on mucocutaneous presentations after COVD-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders. Dermatol Ther 2022; 35:e15461. [PMID: 35316551 PMCID: PMC9111423 DOI: 10.1111/dth.15461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
With dermatologic side effects being fairly prevalent following vaccination against COVID-19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent,in order to provide a thorough body of information about these post-COVID-19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID-19 vaccine administration were retrieved using the following keywords: COVID-19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life-threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non-significant, self-limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare-ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra-indications. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Farnoosh Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Homa Pourriyahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Arash Pour Mohammad
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zoha Shaka
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| |
Collapse
|
18
|
Abstract
Soft tissue lesions commonly seen in the oral cavity tend to overlap in their onset, presentation, and location making it difficult to appreciate their etiology. In some instances, common oral soft tissue lesions can create confusion due to similar clinical appearance or unusual presentation; therefore, proper diagnosis of the lesion is key in pharmacologic management. In ulcerative conditions, topical steroids can decrease the symptoms and improve healing time, but do not affect the recurrence rate. Always be suspicious of soft tissue lesions that are nonresolving or recurrent lesions as they may warrant further investigation to rule out malignancy or associated systemic conditions. This article discusses key clinical presentations and the proper topical and systemic pharmacologic treatments.
Collapse
Affiliation(s)
- Guillermo Puig Arroyo
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA.
| | - Ashley Lofters
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA
| |
Collapse
|
19
|
Moar A, Azzolini A, Tessari G, Schena D, Girolomoni G. Reply to: Non-Bullous Pemphigoid: A Yet-to-Be Defined Disease Entity. Dermatology 2021; 237:1048-1049. [PMID: 34515104 DOI: 10.1159/000518772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Agata Moar
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Alan Azzolini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Gianpaolo Tessari
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
20
|
Solimani F, Didona D, Li J, Bao L, Patel PM, Gasparini G, Kridin K, Cozzani E, Hertl M, Amber KT. Characterizing the proteome of bullous pemphigoid blister fluid utilizing tandem mass tag labeling coupled with LC-MS/MS. Arch Dermatol Res 2021; 314:921-928. [PMID: 34152480 DOI: 10.1007/s00403-021-02253-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
Bullous pemphigoid is an autoimmune blistering disease caused by autoantibodies against components of the cutaneous basement membrane zone. Autoantibodies lead to complement-dependent and -independent inflammation and blistering. Blister fluid is a valuable biologic resource, as it provides insight into both systemic and local microenvironment responses. Here, we utilized liquid chromatography with tandem mass spectrometry to characterize the bullous pemphigoid blister fluid proteome. We then depleted exosomes to better understand the exosomal versus non-exosomal proteome. We identified 339 proteins in the blister fluid of bullous pemphigoid patients. Gene ontology demonstrated enrichment of several key biologic processes including innate immune response, neutrophil degranulation, platelet degranulation, and complement activation. Exosome depletion resulted in a significant decrease in normalized reporter intensities of 192 proteins, consistent with our observation of a large number of exosomal proteins found in the blister fluid. We then compared the bullous pemphigoid blister fluid proteome to prior proteomic datasets in suction blister fluid, snake bites, and thermal burns, identifying 76 proteins unique to bullous pemphigoid. These include major basic protein, eosinophil peroxidase, galectin-10, and the immunoglobulin epsilon heavy constant region, consistent with tissue eosinophilia. We lastly validated several previously reported blister fluid exosomal components. Blister fluid in bullous pemphigoid contains a mixture of numerous biologic processes. While many of these processes are shared with blistering from alternative causes, we have identified several notable features unique to bullous pemphigoid.
Collapse
Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charitèe-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Jing Li
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Lei Bao
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Payal M Patel
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Giulia Gasparini
- Department of Health Sciences and Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Department of Health Sciences (DISSAL), Section of Dermatology, University of Genoa, San Martino Policlinic Hospital IRCCS, Genoa, Italy
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Emanuele Cozzani
- Department of Health Sciences (DISSAL), Section of Dermatology, University of Genoa, San Martino Policlinic Hospital IRCCS, Genoa, Italy
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Kyle T Amber
- Division of Dermatology, Rush University Medical Center, 707 S Wood St. Suite 220, Chicago, IL, USA.
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, 60612, USA.
| |
Collapse
|
21
|
Abstract
Autoimmune blistering diseases are a heterogenous group of dermatological disorders characterized by blisters and erosions of the skin and/or mucous membranes induced by autoantibodies against structural proteins of the desmosome or the dermal-epidermal adhesion complex including the hemidesmosome. They consist of the two major disease groups, pemphigus and pemphigoid diseases (PPDs). The diagnosis is based on clinical findings, histopathology, direct immunofluorescence, and detection of circulating autoantibodies. The pathogenesis is not fully elucidated, prognostic factors are lacking, and to date, there is no cure for PPDs. MicroRNAs (miRNAs) represent small, non-coding RNAs that play a pivotal role in the posttranscriptional regulation of gene expression. Their dysfunction was highlighted to play a significant role in the pathogenesis of various diseases. Even though a link between miRNAs and autoimmune blistering diseases had been suggested, the research of their involvement in the pathogenesis of PPDs is still in its infancy. miRNAs hold promise for uncovering new layers in the pathogenesis of PPDs, in order to improve diagnosis and also to develop potential therapeutic options. In the current article, we provide an overview regarding current knowledge of miRNAs in terms of complex pathogenesis of PPDs, and, also, their potential role as biomarkers, predictive factors and therapeutic targets.
Collapse
Affiliation(s)
- Cristian Papara
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Detlef Zillikens
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany; Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany.
| | - Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany; Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany
| | - Adrian Baican
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
22
|
Jin XX, Wang X, Shan Y, Li SZ, Xu Q, Jin HZ, Zuo YG. Efficacy and safety of tetracyclines for pemphigoid: a systematic review and meta-analysis. Arch Dermatol Res 2021. [PMID: 33774726 DOI: 10.1007/s00403-021-02216-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
The aim of this review was to evaluate the efficacy and safety of tetracyclines for treatment of pemphigoid. We searched PubMed, EMBASE, Ovid, Web of Science, and the Cochrane Library for studies involving pemphigoid patients treated with tetracyclines published in English before 29 February 2020. References of included studies were also screened to widen the scope of the literature search. Data regarding predefined clinical outcomes of 341 patients from 77 studies were extracted and analyzed. A meta-analysis was conducted on the basis of 4 studies including 2 randomized controlled trials and 2 comparative studies. The patients had a mean age of 74.60 ± 13.18 years, 45.4% were males, and 54.6% were females. There were 185 patients with mild-to-moderate and 143 patients with severe disease. The average initial doses were 1.62 ± 0.39 g/day for tetracycline, 0.20 ± 0.01 g/day for doxycycline, and 0.11 ± 0.05 g/day for minocycline. The average time on tetracyclines was 3.74 ± 5.99 months, and 261 (81.3%) patients reported partial or complete remission. Relapses occurred in 72 (28.3%) cases. Adverse effects were experienced by 130 (41.9%) patients. The pooled ORs for short-term effectiveness, relapse, adverse effects, and 1-year survival in patients treated with oral tetracyclines vs. systemic corticosteroids were 0.40 (95% CI, 0.22-0.76), 0.69 (95% CI, 0.44-1.10), 0.47 (95% CI, 0.27-0.82) and 2.02 (95% CI, 1.16-3.50), respectively. Compared to doxycycline and minocycline, tetracycline was significantly associated with better treatment outcomes and fewer adverse effects (p < 0.05). This review revealed tetracyclines' efficacy and safety in pemphigoid treatment and may offer support for clinical use of tetracyclines in pemphigoid.
Collapse
|
23
|
Abstract
Blisters and erosions of skin and mucous membranes are key features of the clinically heterogeneous group of autoimmune bullous diseases (AIBDs). These can be divided into pemphigoid diseases with autoantibodies against structural proteins of the dermal-epidermal junction, pemphigus diseases with autoantibodies against desmosomal proteins, and dermatitis herpetiformis with autoantibodies against transglutaminases 1 and 2. A differentiation based only on clinical features is often not sufficient. After researching the literature in PubMed, the current diagnostic tools for AIBDs are summarized.AIBD diagnostics are performed using histology, direct and indirect immunofluorescence, as well as ELISA and immunoblotting. For serological diagnosis, the conventional multistep approach or multivariant assays for the analysis of autoantibodies against several target antigens in parallel can be applied. These allow a precise classification of AIBD and therefore a tailored use of different therapeutic regimens, e.g., for bullous pemphigoid or pemphigus foliaceus/vulgaris, as well as identification of disease entities with a known association with neoplasia.Direct immunofluorescence is still the diagnostic mainstay of AIBDs. However, novel serological assays, such as target-antigen-specific ELISA or indirect immunofluorescence systems using BIOCHIP™ mosaic technology, allow serologic diagnosis in most AIBD patients and the exact classification of the disease entity at the molecular level.
Collapse
|
24
|
Kim J, Jung T, Kim K, Kim K, Hong S, Baek S, Moon J. Radiation induced pemphigoid disease. Obstet Gynecol Sci 2020; 63:750-2. [PMID: 32981288 DOI: 10.5468/ogs.20088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/23/2020] [Indexed: 11/08/2022] Open
Abstract
Among the possible complications of radiation therapy, acute and chronic side effects on the skin can be induced by percutaneous radiotherapy in the target site. Common skin lesions include radiation dermatitis, which can be treated by topical application of dressing and ointment. Pemphigoid disease, which displays similar clinical features as other skin diseases such as recurrent cancer and herpes zoster, rarely occurs in the site of radiotherapy; therefore, care must be taken during diagnosis for a timely treatment. The present report is a case of pemphigoid disease that had developed in a patient with endometrioid/clear cell carcinoma after radiation therapy, and the time between onset and radiotherapy was more than 6 months.
Collapse
|
25
|
Lee S, Rastogi S, Hsu DY, Nardone B, Silverberg JI. Association of bullous pemphigoid and comorbid health conditions: a case-control study. Arch Dermatol Res 2020; 313:327-332. [PMID: 32647978 DOI: 10.1007/s00403-020-02100-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bullous pemphigoid is an autoimmune skin disease characterized by the formation of blisters between the epidermis and dermis. Comorbidities of pemphigoid have not been well-described. Identification of comorbidities associated with pemphigoid is important to decrease morbidity and mortality. OBJECTIVE To identify the comorbid health conditions of bullous pemphigoid. METHODS This was a case-control study of 91 cases of pemphigoid verified by clinical and laboratory diagnosis and 546 age- and sex-matched controls with complete follow-up at a large metropolitan quaternary care medical center. RESULTS The average age of bullous pemphigoid patients was 76 years and 53% of patients were female. Forty-eight (53%) of the BP patients had a history of inpatient hospitalization, of which 22 (24.2%) were hospitalized for either previously undiagnosed BP or an exacerbation of BP. Bullous pemphigoid was significantly associated with hypertension [adjusted odds ratio (95% confidence interval)]: [2.03 (1.24-3.32)], diabetes mellitus [2.59 (1.60-4.19)], chronic kidney disease [2.29 (1.19-4.40)], end-stage renal disease [3.82 (1.48-9.85)], basal cell carcinoma of the skin [6.00 (1.94-18.6)], and obstructive sleep apnea [5.23 (2.45-11.19)]. 78% of BP patients used at least one systemic immunosuppressant. There was no significant association between treatments for pemphigoid and any of the comorbidities. CONCLUSIONS Bullous pemphigoid patients need screening for comorbid health conditions even though treatment options do not seem to be associated with these comorbidities.
Collapse
Affiliation(s)
- Sherry Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Supriya Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Derek Y Hsu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA. .,Department of Dermatology, George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| |
Collapse
|
26
|
Patsatsi A, Uy CDC, Murrell DF. Multiple milia formation in blistering diseases. Int J Womens Dermatol 2020; 6:199-202. [PMID: 32637544 PMCID: PMC7330451 DOI: 10.1016/j.ijwd.2020.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Milia are superficial keratinous cysts seen as pearly white, dome-shaped lesions 1-2 mm in diameter. Milia are associated with diseases that cause subepidermal blistering, such as hereditary forms of epidermolysis bullosa, epidermolysis bullosa acquisita, bullous pemphigoid, bullous lichen planus, and porphyria cutanea tarda. Multiple eruptive milia are rare and more extensive in number than primary milia. OBJECTIVE The aim of this study was to search the literature for cases of blistering diseases with multiple milia formation, especially in areas of the skin where there was no evidence of blistering or trauma, and review the interpretations of their pathogenesis. METHODS We performed a literature search with the terms multiple milia and bullous diseases, pemphigoid, and pemphigus. RESULTS Very few studies have investigated the origin of milia. Primary milia are thought to originate from the sebaceous collar of vellus hairs, and secondary milia are believed to derive from eccrine ducts more commonly than from overlying epidermis, hair follicles, or sebaceous ducts. Milia secondary to blisters or trauma are speculated to be produced through the regeneration process of disrupted sweat glands or hair follicles. Immunological predisposition, aberrant interaction between the hemidesmosomes, and the extracellular matrix components beneath the hemidesmosomes have been described with regard to the formation of numerous milia during recovery. Multiple milia could be a primary manifestation of dystrophic epidermolysis bullosa in skin areas without evidence of blistering. CONCLUSION The exact etiology of multiple milia remains unknown. Immunological predisposition and improper interaction between hemidesmosomes and extracellular matrix components are speculated to play a role in the formation of milia during recovery of bullous lesions in blistering diseases. Still, further studies on the triggering mechanisms of keratinocyte dysfunction in cases of multiple milia formation without evidence of prior blistering are needed.
Collapse
Affiliation(s)
- Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Cybill Dianne C Uy
- 2nd Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Dedee F Murrell
- Department of Dermatology, University of New South Wales, Sydney, Australia
| |
Collapse
|
27
|
Shaheen MS, Silverberg JI. Association of inflammatory skin diseases with venous thromboembolism in US adults. Arch Dermatol Res 2021; 313:281-9. [PMID: 32642810 DOI: 10.1007/s00403-020-02099-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
Patients with certain inflammatory skin diseases have multiple risk factors for venous thromboembolism (VTE). The objective of the study was to determine whether atopic dermatitis (AD), psoriasis, pemphigus, pemphigoid and/or hidradenitis is associated with VTE in US adults. Data were analyzed from the 2002-2012 Nationwide Inpatient Sample, a representative cohort of US hospitalizations (N = 72,512,581 adults, including 1,389,292 with VTE). In multivariable logistic regression models including age, sex, insurance, household income and race/ethnicity, hospitalization for AD (adjusted odds ratio [95% confidence intervals] 1.22 [1.17-1.27]), pemphigus (1.96 [1.68-2.28]) and pemphigoid (1.64 [1.47-1.83]) was associated with VTE. These associations remained significant in virtually all patient subsets, including males and females, different age groups and those with and without long-term corticosteroid use. In particular, AD, pemphigus and pemphigoid were each associated with DVT and PE. VTE was associated with increased inpatient length of stay, cost of care and mortality across all the inflammatory skin diseases. HS and psoriasis were not consistently associated with VTE. AD, pemphigus and pemphigoid and some subsets of patients with HS were associated with higher odds of hospitalization for VTE. Patients with these inflammatory skin diseases may benefit from increased screening and prevention of VTE.
Collapse
|
28
|
Guo JY, Chen HH, Yang YC, Wu PY, Chang MP, Chen CC. The association of dipeptidyl peptidase IV inhibitors and other risk factors with bullous pemphigoid in patients with type 2 diabetes mellitus: A retrospective cohort study. J Diabetes Complications 2020; 34:107515. [PMID: 31932172 DOI: 10.1016/j.jdiacomp.2019.107515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering skin disorder with unknown etiology. Evidence revealed that dipeptidyl peptidase IV inhibitors (DPP4i) may increase the associated risk. This study aimed to evaluate the relationship of BP with the administration of DPP4i and other risk factors in patients with type 2 diabetes mellitus (T2DM). METHODS Using the Taiwan National Health Insurance Database (NHIRD) from 2009 to 2013, we identified patients with T2DM and the use of DPP4i 12 weeks or greater as a DPP4i cohort and patients with T2DM who never use DPP4i as a control cohort. They were frequency matched on gender and age within 5 years at a ratio of 1:2. The Cox proportional hazard regression model was used to estimate the hazard ratios (HRs) and confidence intervals (CIs) for the cohorts. RESULTS A total of 14,187 individuals taking DPP4i and 28,374 matched cohorts without taking DPP4i were included. The incidence rate of BP was higher in DPP4i cohort than in control cohort (1.41 vs. 0.59 per 1000 person-years; adjusted HR 2.14, 95% CI = 1.02-4.50). The cumulative event rate of BP in DPP4i cohort was higher than in control cohort (log-rank test, p = .01). Patients with dementia and taking spironolactone had a higher associated risk to develop BP; lower associated risk in patients taking metformin. CONCLUSIONS In patients with T2DM, subjects taking DPP4i, having dementia, and taking spironolactone were associated with an increased risk for the development of BP.
Collapse
Affiliation(s)
- Jia-Yin Guo
- Department of Medicine, China Medical University, Taichung 40402, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Hsin-Hung Chen
- Intelligent Diabetes Metabolism and Exercise Center, China Medical University Hospital, Taichung 40447, Taiwan; School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Cih Yang
- Management office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan; School of Medicine, China Medical University, Taichung 40447, Taiwan
| | - Po-Yuan Wu
- School of Medicine, China Medical University, Taichung 40447, Taiwan; Department of Dermatology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Man-Ping Chang
- Department of Nursing, School of Health, National Taichung University of Science and Technology, Taichung 40343, Taiwan
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
| |
Collapse
|
29
|
Sirikham T, Tawanwongsri W, Rutnin S, Chanprapaph K, Vachiramon V. Exfoliative Erythroderma: An Unusual Presentation of Paraneoplastic Pemphigus Associated with Castleman's Disease. Case Rep Dermatol 2020; 12:76-81. [PMID: 32355489 PMCID: PMC7184796 DOI: 10.1159/000507357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/19/2020] [Indexed: 12/02/2022] Open
Abstract
We report a 23-year-old woman who presented with generalized scaly erythematous rash predominately on the upper trunk and hemorrhagic stomatitis. The histopathologic and immunopathologic findings were consistent with the diagnosis of paraneoplastic pemphigus. Castleman's tumor was diagnosed with computed tomography and exploratory laparotomy. A partial clinical improvement was observed after complete tumor removal and intravenous immunoglobulin administration. However, the patient died as a result of septicemia.
Collapse
Affiliation(s)
- Thirawut Sirikham
- Division of Dermatology, Department of Medicine, Suratthani Hospital, Suratthani, Thailand.,Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weeratian Tawanwongsri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
30
|
Chovatiya R, Silverberg JI. Association of pemphigus and pemphigoid with osteoporosis and pathological fractures. Arch Dermatol Res 2019; 312:263-271. [PMID: 31741052 DOI: 10.1007/s00403-019-02010-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/05/2019] [Indexed: 01/25/2023]
Abstract
Patients with pemphigus and bullous pemphigoid (BP) have potential risk factors for osteoporosis and/or fractures. To determine whether pemphigus and BP are associated with osteoporosis and fractures in the US, a cross-sectional study of 198,102,435 adults was performed, including 4506 with pemphigus and 8864 with BP from the 2006-2012 National Emergency Department Sample, a 20% sample of emergency care visits throughout the US. Pemphigus was associated with higher odds (multivariate logistic regression; adjusted odds ratio [95% confidence intervals]) of osteopenia (2.20 [1.59-3.05]), osteoporosis (2.54 [2.16-2.98]), osteomalacia (29.70 [4.05-217.83]), and pathological fractures (2.04 [1.42-2.91]). BP was associated with osteoporosis (1.55 [1.39-1.73]) and pathological fractures (1.52 [1.22-1.88]). When compared to BP, pemphigus was associated with higher odds of osteopenia (1.59 [1.06-2.41]), osteoporosis (1.38 [1.18-1.63]), and fractures (1.26 [1.04-1.53]), particularly of the ulna and radius (3.17 [1.23-8.17]). Patients with pemphigus or BP as well as long-term systemic corticosteroid use had highest odds of osteoporosis and fractures. No data were available on treatments for pemphigus or BP. Pemphigus and BP were associated with osteopenia, osteoporosis, and pathologic fractures. Patients with PEM and BP may benefit from increased screening for osteoporosis and interventions to prevent fractures.
Collapse
Affiliation(s)
- Raj Chovatiya
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N. St. Clair St., Chicago, IL, 60611, USA.
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA
| |
Collapse
|
31
|
Xie D, Bilgic-Temel A, Abu Alrub N, Murrell DF. Alopecia in Autoimmune Blistering Diseases: A Systematic Review of Pathogenesis and Clinical Features of Disease. Skin Appendage Disord 2019; 5:263-275. [PMID: 31559249 DOI: 10.1159/000496836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Autoimmune blistering diseases (AIBD) are characterised by the body's production of autoantibodies against structural proteins in the epidermis and/or the basement membrane on cutaneous and mucosal surfaces. Alopecia is a complication of AIBD that has generally been overlooked in patients with severe blistering diseases because it is regarded as a cosmetic issue. Yet recent research into quality of life tools has found that stigmatisation by appearance plays a significant role in blistering diseases. Aim To review the current literature detailing the pathogenesis and clinical presentations of alopecia in AIBD patients. Method We searched Medline, PubMed and EMBASE electronic databases up to September 2018, for empirical human and animal studies. Results Only 36 human studies including 223 patients (190 pemphigus, 25 pemphigoid, 5 epidermolysis bullosa acquisita, 2 dermatitis herpetiformis and 1 linear IgA disease) detailed demographic and clinical manifestations of alopecia. A range of hair evaluation methods was demonstrated to reach alopecia diagnosis. Furthermore, with no universal validated scoring system for alopecia severity, alopecia patterns have been summarised. Conclusion Previous randomised trials have not highlighted alopecia as an important outcome of AIBD, so epidemiological evaluation of the available literature has been helpful in summarising trends between existing studies and demonstrating inconsistencies.
Collapse
Affiliation(s)
- Danica Xie
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Asli Bilgic-Temel
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia
| | - Nada Abu Alrub
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia
| | - Dédée F Murrell
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
32
|
Abstract
Autoimmmune bullous diseases are mediated by pathogenetically relevant autoantibodies against components of the epidermis and/or superficial mucous membranes (in pemphigus) and structural proteins of the dermal-epidermal junction (in pemphigoid diseases). Using immunoadsorption (IA), an already well-established procedure in cardiac and rheumatic disorders, antibodies can be removed from the plasma. At present, most data on the adjuvant use of IA in dermatology are derived from patients with severe and/or refractory pemphigus vulgaris or pemphigus foliaceus and also from patients with pemphigoid diseases. Additionally, in the last few years different protocols for IA in patients with severe atopic dermatitis and elevated total serum IgE levels have been published. While panimmunoglobulin adsorbers are mainly used in dermatology, an IgE-specific adsorber has been used in some patients with atopic dermatitis and in the future, antigen-specific adsorbers are to be expected that will enable the specific reduction of autoantibodies.
Collapse
Affiliation(s)
- Franziska Hübner
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Michael Kasperkiewicz
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Detlef Zillikens
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Enno Schmidt
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. .,Lübecker Institut für Experimentelle Dermatologie (LIED), Universität zu Lübeck, Lübeck, Deutschland.
| |
Collapse
|
33
|
Reis Gavazzoni Dias MF, Aparecida Guedes Vilar E, de Oliveira Bento C, Barreto Ibanez R, Falci Loures A, Barreto Oliveira Campos M, Monaco Santos J. Brunsting-Perry Type Pemphigoid Causing Secondary Cicatricial Alopecia in 2 Patients. Skin Appendage Disord 2018; 4:308-311. [PMID: 30410903 DOI: 10.1159/000485570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022] Open
Abstract
Brunsting-Perry type pemphigoid (BPP) is a rare subepidermal blistering disease and a cause of secondary cicatricial alopecia. It was originally described by Brunsting and Perry in 1957 as a rare variant of cicatricial pemphigoid, characterized by bullous lesions limited to the head, neck, scalp, and upper trunk with mild or no mucosal involvement. We report 2 cases of BPP cicatricial alopecia with histopathology of subepidermal blister formation, different clinical presentation, and different salt-split test results. One patient had features of bullous pemphigoid (BP) with important oral mucosal involvement (not yet reported in the literature), and the second patient had typical features of epidermolysis bullosa acquisita (EBA). The secondary cicatricial alopecia may be due to different antigens associated with either BP or EBA. The phenomenon of epitope spreading could explain the association between 2 distinctive bullous diseases in the same patient, justifying the divergent findings of the immunofluorescence. The specific target antigen of BPP is yet to be defined.
Collapse
|
34
|
Rozenblat M, Halaj A, Rozenblat T, Fisher S, Sah M, Dodiuk-Gad RP, Ziv M. Mortality and risk factors among Israeli bullous pemphigoid patients. Arch Dermatol Res 2018; 311:19-27. [PMID: 30382340 DOI: 10.1007/s00403-018-1875-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
There are differences concerning reported mortality rates and prognostic factors of bullous pemphigoid (BP) patients in different studies. Our objectives were to evaluate the mortality rates and prognostic factors among Israeli BP patients compared to matched control subjects. Three age- and sex-matched patients without BP (n = 261) who were treated in our clinic were selected and compared to BP patients (n = 87). Mean survival period of the BP group was 4.1 years (95% CI: 3.3-4.8 years) and 5.9 years among the non-BP group (95% CI: 5.6-6.3 years). The 1-year mortality rate was 24.1% for the BP group and 6.5% for the control group. In multivariate analysis, age above 80 was a significant risk factor for mortality [HR 3.22 (95% CI, 1.15-8.96), p = 0.03], while statins intake had a protective role [HR 0.36 (95% CI, 0.15-0.88), p = 0.03]. In univariant analysis, dementia [HR 2.44 (95% CI, 1.02-5.99), p = 0.04] was a risk factor. In conclusion, BP patients' mortality is correlated to increasing age at diagnosis, dementia, and statins use. Statins' protective role is newly discussed in the literature.
Collapse
Affiliation(s)
- Mati Rozenblat
- Department of Dermatology, Emek Medical Center, Afula, Israel.
| | - Awad Halaj
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Tal Rozenblat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Fisher
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Mohammad Sah
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | | | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| |
Collapse
|
35
|
Abstract
Humoral immunity is the cause of multiple diseases related to antibodies (IgA, IgG, IgM) produced by the patient. Two groups of diseases are identified. The first group is related to circulating antigen-antibody complexes. The antigens are various. They are often unknown. These immune complexes cause a vascular inflammation due to the complement fixation. Consequently, this group is dominated by inflammatory vasculitis. In the second group, the pathology is due to the fixation in situ of antibodies to a target antigen of the skin that is no more recognized by the patient. This group is represented by the auto-immune bullous dermatoses.
Collapse
Affiliation(s)
- Janine Wechsler
- Département de pathologie, service d'anatomie et de cytologie pathologiques, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| |
Collapse
|
36
|
Chagury AA, Sennes LU, Gil JM, Kalil J, Rodrigues H, Rosales CB, Miziara ID. HLA-C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 Alleles Associated to Bullous Pemphigoid in Brazilian Population. Ann Dermatol 2017; 30:8-12. [PMID: 29386826 PMCID: PMC5762482 DOI: 10.5021/ad.2018.30.1.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 11/08/2022] Open
Abstract
Background Bullous pemphigoid (BP) is an autoimmune disease with bullous vesicles and an incidence of 0.2 to 1.4 per 100,000 inhabitants. Many studies have been published demonstrating the association of pemphigoid with HLA class II system alleles in different populations, however there are no data on the BP, one of the most heterogeneous in the world. Objective To typify HLA alleles in Brazilians with Bullous pemphigoid. Methods The study group included 17 Brazilian patients with a confirmed diagnosis of BP from a hospital in Sao Paulo city, southeast Brazil. DNA was extracted from peripheral blood using Qiagen kits and HLA A, B, C, DR and DQ typing was performed using polymerase chain reaction. The control group was composed of a database of 297 deceased donors from the city of Sao Paulo. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA class I (A, B and C) and class II (DRB1, DQB1 and DQA1). Results Our findings show that alleles HLA C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 are associated with the onset of the disease in the Brazilian population, with relative risks of 8.31 (2.46 to 28.16), 3.76 (1.81 to 7.79), 3.57 (1.53 to 8.33), and 4.02 (1.87 to 8.64), respectively (p<0.005). Conclusion Our data indicate that Brazilian patients with BP present the same genetic predisposition linked to HLA-DQB1*03:01 previously reported in Caucasian and Iranian individuals and our study introduces three new alleles (C*17, DQA1*01:03 and DQA1*05:05) involved in the pathophysiology of BP.
Collapse
Affiliation(s)
- Azis Arruda Chagury
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Luiz Ubirajara Sennes
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Julio Miranda Gil
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Jorge Kalil
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Helcio Rodrigues
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Claudia B Rosales
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Ivan Dieb Miziara
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| |
Collapse
|
37
|
Abstract
Autoimmmune bullous diseases of skin and mucosa are uncommon, disabling, and potentially lethal diseases. For a quick and reliable diagnosis immunofluorescence is essential. This article describes two variants of immunofluorescence. The direct method uses a skin or mucosal biopsy of the patient to detect in vivo bound antibodies. Indirect immunofluorescence uses patient's serum and a substrate to visualize circulating autoantibodies. These two methods supplemented with advanced techniques allow reliable classification of autoimmune bullous diseases; not only the main entities pemphigus and pemphigoid, but also subclasses within these groups. This is important because prognosis and therapy vary among different variants of autoimmune bullous diseases.
Collapse
Affiliation(s)
- Gilles F Diercks
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Hendri H Pas
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel F Jonkman
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
38
|
Fujio Y, Kojima K, Hashiguchi M, Wakui M, Murata M, Amagai M, Yamagami J. Validation of chemiluminescent enzyme immunoassay in detection of autoantibodies in pemphigus and pemphigoid. J Dermatol Sci 2017; 85:208-215. [PMID: 28012821 DOI: 10.1016/j.jdermsci.2016.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/24/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A novel chemiluminescent enzyme immunoassay (CLEIA) was recently developed to quantify autoantibodies specific for desmogleins (Dsgs) and BP180, the target antigens of pemphigus and pemphigoid. This assay is automated and highly accurate and efficient. OBJECTIVE To validate the use of the CLEIA for detection of autoantibodies during the clinical courses of patients with pemphigus and pemphigoid. METHODS To define cut-off values for Dsg1, Dsg3, and BP180, we evaluated 47 serum samples from patients with pemphigus foliaceus (PF), 59 from those with pemphigus vulgaris (PV), 52 from those with bullous pemphigoid (BP), and 995 from healthy individuals. We also evaluated any fluctuations in CLEIA titers according to disease activity during the clinical course of 10 cases each of PF, PV, and BP. We used clinical symptom scores, the pemphigus disease area index (PDAI) and the bullous pemphigoid disease area index (BPDAI), to evaluate disease activity. RESULTS The cut-off values for the CLEIA titers determined by the Youden index were 15.4U/mL for Dsg1, 14.9U/mL for Dsg3, and 16.8U/mL for BP180. CLEIA titers fluctuated in parallel with the PDAI/BPDAI scores in 28 of the 30 cases with PF, PV, or BP. Although the CLEIA and enzyme-linked immunosorbent assay (ELISA) values in the same samples differed substantially in some cases, the concordance rates of positive/negative results between the CLEIA and ELISA were 96% for Dsg1, 97% for Dsg3, and 96% for BP180. CONCLUSION The CLEIA, a newly developed, highly effective autoantibody detection system, is as reliable as ELISA for evaluation of the clinical courses of pemphigus and pemphigoid.
Collapse
Affiliation(s)
- Yumi Fujio
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Kazuo Kojima
- Medical & Biological Laboratories Co., LTD, 4-5-3 Sakae, Naka-Ku, Nagoya, Aichi, 460-0008, Japan.
| | - Masahiro Hashiguchi
- Medical & Biological Laboratories Co., LTD, 4-5-3 Sakae, Naka-Ku, Nagoya, Aichi, 460-0008, Japan.
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| |
Collapse
|
39
|
Abstract
Immune-related disorders of the oral cavity may occur as primary disease process, secondary to systemic disease or neoplasm, or as a reaction to medications and other agents. The entities represented within this group may vary significantly by severity, clinical presentation, microscopic presentation, and special testing results. The selected immune-related conditions of the oral cavity in this article are categorized and presented by their prototypical tissue reaction patterns: vesiculobullous, including acantholytic and subepithelial separation; psoriasiform; spongiotic; and lichenoid reaction patterns.
Collapse
Affiliation(s)
- Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, 500 Peachtree Street Northeast, Atlanta, GA 30308, USA.
| | - Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida, 1395 Center Drive, Gainesville, FL 32610, USA
| |
Collapse
|
40
|
Abstract
Several dermatoses are typified by the formation of spaces (blisters; bullae) within or beneath the epidermis. These may be acellular or filled with particular species of inflammatory cells. Etiological categories include infectious, immune-mediated, genetic, drug-related, and idiopathic lesions. Examples of such disorders include impetigo, Herpes virus infections, pemphigus, bullous pemphigoid and pemphigoid gestationis, epidermolysis bullosa acquisita, IgA-related dermatoses, inherited epidermolysis bullosa variants, Hailey-Hailey disease, and porphyria cutanea tarda. Other conditions manifest microscopic acantholysis within the surface epithelium but are not associated with clinical bullae, such as Darier disease and Grover disease. Finally, both infectious and non-infectious causes exist for the development of neutrophilic pustules in the epidermis, as seen in pustular psoriasis, Sneddon-Wilkinson disease (subcorneal pustular dermatosis), and acute generalized exanthematous pustulosis. This review considers the clinical and histological features of all of these diseases.
Collapse
Affiliation(s)
- Mark R Wick
- Section of Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, United States.
| |
Collapse
|
41
|
Abstract
Bullous autoimmune diseases are organ-specific disorders characterized by an autoantibody-mediated blistering of skin and mucous membranes. The detection of tissue-bound and serum autoantibodies is prerequisite for the diagnosis of autoimmune blistering diseases. The individual entities of this group may be difficult to differentiate on clinical grounds alone. An accurate diagnosis is however important for prognosis and therapy. A preliminary diagnostic step includes direct and indirect immunofluorescence microscopy, which provide information about the binding pattern and isotype of autoantibodies and allow the diagnosis of the autoimmune blistering disease. Subsequent characterization of the molecular specificity of autoantibodies is necessary for the exact classification of autoimmune bullous dermatoses. The quantitative measurement of autoantibodies against structural proteins of the skin may be often used to assess disease severity at follow-up.
Collapse
Affiliation(s)
- K Hoffmann
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Hauptstraße 7, 79104, Freiburg, Deutschland
| | - M Hertl
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - C Sitaru
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Hauptstraße 7, 79104, Freiburg, Deutschland. .,MVZ Labor Clotten, Merzhauserstr. 112A, 79100, Freiburg, Deutschland.
| |
Collapse
|
42
|
Abstract
Significant advances have been performed in cutaneous adverse reactions leading to primary prevention strategy and implication of new signaling pathways. Histological features of DRESS and methotrexate toxicity are detailed. New emerging infectious agents are reported including Zika Virus, an arbovirus which can be confused with dengue or chikungunya, a new cowpox virus transmitted by domestic cat leading to lymphadenitis, Spirurina type X larva transmitted in Japan by eating raw squid or fish. Malignancies in pemphigus and pemphigoid are emphasized. Expert recommandations are developped on definitions, diagnosis and disease activity of mucous membrane pemphigoid, bubllous pemphigoid and pemphigus. Psoriasis and cardiometabolic association are discussed. This risk association appears higher in hidradenitis suppurativa, which seems more frequent in patients of African ancestry. IgG4-related disease is an immune mediated entity characterized by fibroinflammatory lesions often misdiagnosed. Pruritus, heat sensations, numbness could be recognized as a small-fiber neuropathy symptoms. Burden impact in common dermatosis is demonstrated and should be integrated in our daily practice.
Collapse
Affiliation(s)
- L Valeyrie-Allanore
- Service de dermatologie, centre de référence des maladies bulleuses immunologiques et toxiques, AP-HP, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil Cedex ; université Paris-Est Créteil, Créteil, France.
| |
Collapse
|
43
|
Florea F, Koch M, Hashimoto T, Sitaru C. Autoimmunity against laminins. Clin Immunol 2016; 170:39-52. [PMID: 27464450 DOI: 10.1016/j.clim.2016.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/30/2016] [Accepted: 07/22/2016] [Indexed: 12/12/2022]
Abstract
Laminins are ubiquitous constituents of the basement membranes with major architectural and functional role as supported by the fact that absence or mutations of laminins lead to either lethal or severely impairing phenotypes. Besides genetic defects, laminins are involved in a wide range of human diseases including cancer, infections, and inflammatory diseases, as well as autoimmune disorders. A growing body of evidence implicates several laminin chains as autoantigens in blistering skin diseases, collagenoses, vasculitis, or post-infectious autoimmunity. The current paper reviews the existing knowledge on autoimmunity against laminins referring to both experimental and clinical data, and on therapeutic implications of anti-laminin antibodies. Further investigation of relevant laminin epitopes in pathogenic autoimmunity would facilitate the development of appropriate diagnostic tools for thorough characterization of patients' antibody specificities and should decisively contribute to designing more specific therapeutic interventions.
Collapse
|
44
|
Keller JJ, Kittridge AL, Debanne SM, Korman NJ. Evaluation of ELISA testing for BP180 and BP230 as a diagnostic modality for bullous pemphigoid: a clinical experience. Arch Dermatol Res 2016; 308:269-72. [PMID: 26895534 DOI: 10.1007/s00403-016-1631-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/17/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering disorder of the elderly. Several diagnostic modalities are available, including clinical impression, histopathology, direct and indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) detection of pathogenic antibodies. In this study, we aim to examine the utility of the newest test, ELISA, in comparison to the constellation of other tests. We describe our clinical experience in which 170 patients diagnosed with bullous pemphigoid had multiple tests performed. BP180 alone showed a sensitivity of 54 % and specificity of 94 %. The positive predictive value (PPV) is 95 % while the negative predictive value (NPV) is 52 %. BP230 alone yielded a sensitivity of 48 % and specificity of 94 %. The PPV is 94 % and the NPV is 49 %. Using both tests in combination yielded a sensitivity of 66 % and specificity of 89 %. The PPV of at least one of two tests returning positive is 92 % while the NPV of dual negative tests is 58 %. Use of ELISAs for suspected cases of BP are an inadequate standalone test, and are only helpful in making the diagnosis should they return positive. However, they would appear to miss about one-third of cases.
Collapse
Affiliation(s)
- Jesse J Keller
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA.
| | | | - Sara M Debanne
- Department of Epidemiology, Case Western Reserve University, 10900 Euclid Ave, Wood Building WG51, Cleveland, OH, 44106, USA
| | - Neil J Korman
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA
| |
Collapse
|
45
|
Abstract
The oral ulcerations caused by aphtous lesions, herpetic lesions, candidiasis, ulcerative lichen planus, mucous membrane pemphigoid, and pemphigus vulgaris are managed in a step-up approach that can involve topical, intarlesional, and systemic pharmacologic management. This article reviews the common treatment agents, modalities, and dosages. The emphasis is on local pharmacologic therapies, yet systemic conditions that often present with such oral lesions are briefly reviewed, along with the appropriate management.
Collapse
Affiliation(s)
- Mihai Radulescu
- Oral Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
| |
Collapse
|
46
|
Abstract
Dermatoses have been better characterized as hypochromic vitiligo in subjects with dark skin or the acquired racquet nails associated with hyperparathyroidism. The innate immunity has a central role in the new classification of auto inflammatory diseases, neutrophilic dermatoses, neutrophilic urticaria or pseudo-neutrophilic urticaria. Comorbidities have been studied e.g. cardiovascular co morbidities for psoriasis, IBD associated with hidradenitis suppurativa or neurological disorders associated with pemphigoid. Bullous pemphigoid could be renamed as cutaneous pemphigoid, it can be induced by drugs especially gliptins. Genetic predispositions are analyzed in auto inflammatory diseases, psoriasis (HLA), drug eruptions (HLA or cytokines). Telaprevir often induces rashes, which can be severe but other treatments against hepatitis C as interferon can also induce debilitating rashes, some eligible for drug tolerance induction. European guidelines for the definition, classification, diagnosis of chronic spontaneous urticaria have been published. Severe cutaneous adverse drug reactions may be associated with severe systemic symptoms such as organ involvement in AGEP or the occurrence of a shock in DRESS. Allover Europe, there is now an epidemic of contact allergies to methylisothiazolinone (MIT), contained in cosmetics, wet wipes but also in paints. MIT should be tested at 2.000 ppm in water, included in the standard series for patch tests. Its role has to be evoked in any case localized on the face or hand, airborne or generalized eczema. Among infectious diseases, skin manifestations due to Parvovirus have been specified, a febrile rash can be related to dengue infection or to Zika virus.
Collapse
Affiliation(s)
- A Barbaud
- Département de dermatologie et allergologie, bâtiment des spécialités médicales, hôpitaux de Brabois, centre hospitalo-universitaire de Nancy, 54500 Vandœuvre-les-Nancy, France.
| |
Collapse
|
47
|
Zhao CY, Murrell DF. Autoimmune blistering diseases in females: a review. Int J Womens Dermatol 2015; 1:4-12. [PMID: 28491949 DOI: 10.1016/j.ijwd.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/23/2014] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
The autoimmune blistering diseases (AIBDs) are a group of heterogeneous skin diseases with autoantibodies directed against structural proteins in the skin. A new interest in the female bias towards autoimmune diseases in general has led to our attention to focus on how and why this female bias manifests in AIBD. The authors aim to review and explore the various aspects of AIBD affecting females more than males, including the higher prevalence, worse quality of life, and complex management issues such as pregnancy and lactation. What is already known on this topic? Echoing autoimmune diseases in general, most autoimmune blistering diseases (AIBDs) have a female predominance, but the exact level of predominance is unknown. Pregnancy raises several complicated management issues for females with an AIBD.
What does this article add to our knowledge? Review of sex-specific epidemiology and etiology of each AIBD. Exploration and explanation of the key factors underlying the detrimental impacts of AIBD on women’s quality of life (QOL). Discussion of management issues in pregnancy and lactation for females with an AIBD.
How does this information impact clinical practice and/or change patient care? An awareness and understanding of the female predominance in AIBDs will ensure more appropriate diagnosis, evaluation, and future research. Emphasizing holistic care targeting the debilitating effects of AIBDs on women’s QOL. Informing the reader of optimal, yet safe interventions for pregnant women with an AIBD.
Collapse
|
48
|
Gurel MS, Savas S, Bilgin F, Erdil D, Leblebici C, Sarikaya E. Zosteriform pemphigoid after zoster: Wolf's isotopic response. Int Wound J 2015; 13:141-2. [PMID: 25659195 DOI: 10.1111/iwj.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/11/2015] [Indexed: 11/30/2022] Open
Abstract
The Wolf isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed disease. The most common primary skin disorder of this phenomenon is herpes zoster and less frequently, herpes simplex. We report a case of 79-year-old woman who have bullous pemphigoid (BP) with dermatomal distribution that developed at the site of previously healed herpes zoster. Based on clinical, histological and immunofluorescence findings, the patient was diagnosed with localized BP in a site of prior herpes zoster. BP developing at the site of healed herpes zoster is the first reported case. Recognition of this phenomenon is important for correct clinicopathologic diagnosis and may improve our understanding of the underlying pathophysiologic processes.
Collapse
Affiliation(s)
- Mehmet S Gurel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sevil Savas
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Fusun Bilgin
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ebru Sarikaya
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
49
|
Abstract
Oral mucosal diseases encompass several common conditions that affect the general population. Some of these disorders present with signs and symptoms that are pathognomonic for the condition, whereas others present with similar features that can make clinical diagnosis difficult to achieve. It is important for physicians to have a clear understanding of these disorders to provide appropriate care to patients. This article reviews clinical aspects of common oral mucosal disorders, including candidiasis, herpes simplex viral infections, aphthous stomatitis, lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid.
Collapse
Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| |
Collapse
|
50
|
Błasiak-Kołacińska N, Pietruszewska W, Grzelak P, Raźniewski M, Stefańczyk L, Majos A. Rare infraglottic lesions in magnetic resonance imaging. Pol J Radiol 2014; 79:305-10. [PMID: 25228940 PMCID: PMC4162451 DOI: 10.12659/pjr.890521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Primary pathological laryngeal lesions occur rarely in infraglottic space. Modern possibilities of diagnostic imaging of infraglottic space include computed tomography (CT) and magnetic resonance (MR). Diagnostic imaging was performed in potential lesions in this area: inflammatory process – cicatrical pemphigoid, benign neoplastic process – chondroma, malignant neoplastic – squamous cell carcinoma. The aim of the paper is to present clinical and radiographical characteristics of selected lesions located in infraglottic space in MRI examination. Material/Methods Three patients examined at the Department of Radiology and Diagnostic Imaging of University Hospital No. 1 in Lodz (SPZOZ USK nr 1) from 2010–2011 with a pathological mass in infraglottic space. Standard imaging protocol for MRI of the neck was used in all patients: field of 1.5 T, slice thickness 3 mm, the distance between the scans 10–20%, FOV – 3 mm, sequences: T1 (TR/TE 455/9, 7 ms, T2 (TR/TE 5300/67 ms), T1 + Gd-DTPA (contrast agent Gd-DTPA at 0.2 mmol/kg). Conclusions 1. It is possible to determine characteristic signal pattern for rare lesions of the infraglottic space in MRI. 2. MRI is a valuable complementary modality for the diagnostics and differentiation of lesions in infraglottic space, the evaluation of their advancement and treatment planning.
Collapse
Affiliation(s)
- Nina Błasiak-Kołacińska
- Department of Radiology - Diagnostic Imaging, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology and Oncological Laryngology, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| | - Piotr Grzelak
- Department of Radiology - Diagnostic Imaging, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| | - Marek Raźniewski
- Department of Radiology - Diagnostic Imaging, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology - Diagnostic Imaging, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| | - Agata Majos
- Department of Radiology - Diagnostic Imaging, Medical University of Łódź, N. Barlicki University Hospital No. 1, Łódź, Poland
| |
Collapse
|