1
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Wang R, Wang M. A case of herpetiform pemphigus mimicking bullous pemphigoid after using secukinumab and successfully treated with sulfasalazine. J Dermatol 2023; 50:1625-1628. [PMID: 37641883 DOI: 10.1111/1346-8138.16936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
Interleukin 17A (IL-17A) inhibitors, such as secukinumab, have been widely used as the mainstream treatment for chronic plaque psoriasis; however, cutaneous adverse events have been reported. Here, we report a 43-year-old Chinese man who developed herpetiform pemphigus (HP) during secukinumab treatment for his psoriasis. He presented with (1) clinical features of HP, which resembled bullous pemphigoid; histopathological features of intraepidermal blisters, eosinophilic/neutrophilic spongiosis, and liquefactive degeneration of the basal cell layer; (3) positive anti-desmoglein 1 antibody by enzyme-linked immunosorbent assay and cell surface IgG reactivity within the epidermis by indirect immunofluorescence assay; and (4) a satisfactory response to salicylazosulfapyridine (sulfasalazine). To the best of our knowledge, this is the first report of the development of HP after the use of secukinumab for psoriasis.
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Affiliation(s)
- Rui Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Mingyue Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
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2
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Daniels P, Mahmoodi M, Lim S. A patient with a corticosteroid-resistant pruritic rash. Int J Dermatol 2023; 62:1349-1351. [PMID: 36468817 DOI: 10.1111/ijd.16539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/21/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Phuong Daniels
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Scott Lim
- Scott J.M. Lim, DO LLC, Erie, PA, USA
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3
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Montagnon CM, Tolkachjov SN, Murrell DF, Camilleri MJ, Lehman JS. Intraepithelial autoimmune blistering dermatoses: Clinical features and diagnosis. J Am Acad Dermatol 2021; 84:1507-1519. [PMID: 33684498 DOI: 10.1016/j.jaad.2020.11.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 01/21/2023]
Abstract
Intraepithelial autoimmune blistering dermatoses are a rare group of skin disorders characterized by the intraepithelial disruption of intercellular connections through the action of autoantibodies. The first article in this continuing medical education series explores the background, epidemiology, clinical features, and diagnostic criteria of each of the major intraepithelial autoimmune blistering dermatoses, including pemphigus foliaceus, pemphigus erythematosus, pemphigus herpetiformis, fogo selvagem, pemphigus vulgaris, pemphigus vegetans, drug-induced pemphigus, IgA pemphigus, IgG/IgA pemphigus, and paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome.
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Affiliation(s)
| | | | - Dedee F Murrell
- Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Michael J Camilleri
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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4
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Pruritic Blistering Eruption: Answer. Am J Dermatopathol 2020; 42:144-145. [PMID: 31990703 DOI: 10.1097/dad.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Costa LMC, Cappel MA, Keeling JH. Clinical, pathologic, and immunologic features of pemphigus herpetiformis: a literature review and proposed diagnostic criteria. Int J Dermatol 2019; 58:997-1007. [DOI: 10.1111/ijd.14395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - Mark A. Cappel
- Department of Dermatology Mayo Clinic Jacksonville FL USA
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6
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Jerbi A, Hachicha H, Feki S, Bahloul E, Sellami K, Abida O, Charfi S, Bouzid A, Sellami Boudawara T, Turki H, Masmoudi A, Masmoudi H. Pemphigus herpetiformis in South Tunisia: a clinical expression of pemphigus foliaceus? Int J Dermatol 2018; 57:1094-1101. [DOI: 10.1111/ijd.14139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ameni Jerbi
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | - Hend Hachicha
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | - Sawsan Feki
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | - Emna Bahloul
- Dermatology Department; Hedi Chaker Hospital; University of Sfax; Sfax Tunisia
| | - Khadija Sellami
- Dermatology Department; Hedi Chaker Hospital; University of Sfax; Sfax Tunisia
| | - Olfa Abida
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | - Slim Charfi
- Pathology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | - Amina Bouzid
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
| | | | - Hamida Turki
- Dermatology Department; Hedi Chaker Hospital; University of Sfax; Sfax Tunisia
| | | | - Hatem Masmoudi
- Immunology Department; Habib Bourguiba Hospital; University of Sfax; Sfax Tunisia
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7
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Ishiura N, Tamura-Nakano M, Okochi H, Tateishi C, Maki M, Shimoda Y, Ishii N, Hashimoto T, Tamaki T. Herpetiform pemphigus with characteristic transmission electron microscopic findings of various-sized ballooning vacuoles in keratinocytes without acantholysis. Br J Dermatol 2018; 180:187-192. [PMID: 29573413 DOI: 10.1111/bjd.16554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/27/2022]
Abstract
We report a unique case of a Japanese woman with herpetiform pemphigus (HP) who had IgG autoantibodies reactive with nondesmosomal sites of keratinocytes and presented characteristic transmission electron microscopic (TEM) findings of various-sized vacuoles in keratinocytes without acantholysis. The patient presented with pruritic annular oedematous erythemas with small blisters lining the margins on the trunk and extremities. Histopathological examinations showed intraepidermal blisters with prominent infiltrations of eosinophils. Direct and indirect immunofluorescence tests revealed the presence of in vivo bound and circulating IgG autoantibodies to the keratinocyte cell surfaces. However, enzyme-linked immunosorbent assays for desmoglein (Dsg) 1, Dsg3 and desmocollins 1-3 showed negative results. Immunoblotting using the full-length human Dsg1 recombinant protein showed a positive band. TEM examination showed various-sized vacuoles squashing the nuclei in many keratinocytes, resulting in rupture of the cells. Immunoelectron microscopic examination revealed IgG deposition over the entire keratinocyte cell surfaces, which spared the desmosomes. IgG antibodies were also present on the inside walls of the vacuoles around the nuclei of keratinocytes and on the cell surfaces of infiltrating eosinophils. This patient also had marked eosinophilia and high levels of thymus and activation-regulated chemokine and interleukin-5 in the serum. These results indicated a novel autoantigen on the nondesmosomal keratinocyte cell surfaces and the pathogenesis of bullous spongiotic change with inflammation in HP.
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Affiliation(s)
- N Ishiura
- Department of Dermatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - M Tamura-Nakano
- Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - H Okochi
- Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - C Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - M Maki
- Department of General Internal Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Y Shimoda
- Department of Dermatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - N Ishii
- Department of Dermatology, Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology, 67 Asahichou, Kurume, Fukuoka, 830-0011, Japan
| | - T Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - T Tamaki
- Department of Dermatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
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8
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De Pasquale R, Scuderi L, Caltabiano R, Russo G, D'urso DF, Condorelli AG. A rare case of pemphigus herpetiformis in a young woman. GIORN ITAL DERMAT V 2018; 155:229-231. [PMID: 29781259 DOI: 10.23736/s0392-0488.18.05866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rocco De Pasquale
- Department of Dermatology, Vittorio Emanuele Polyclinic Hospital, Catania, Italy
| | - Laura Scuderi
- Department of Dermatology, Vittorio Emanuele Polyclinic Hospital, Catania, Italy
| | - Rosario Caltabiano
- Section of Anatomic Pathology, Department G.F. Ingrassia, University of Catania, Catania, Italy
| | - Guido Russo
- Department of Dermatology, Vittorio Emanuele Polyclinic Hospital, Catania, Italy
| | - Dario F D'urso
- Department of Dermatology, Vittorio Emanuele Polyclinic Hospital, Catania, Italy
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9
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Shimada N, Nakagawa Y, Kamitani K, Murota H, Katayama I. A case of pemphigus herpetiformis associated with a progressive gastric cancer and negative envoplakin and periplakin autoantibodies. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Natsuko Shimada
- Department of Dermatology, Course of Integrated Medicine; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Yukinobu Nakagawa
- Department of Dermatology, Course of Integrated Medicine; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Kaori Kamitani
- Department of Dermatology, Course of Integrated Medicine; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Hiroyuki Murota
- Department of Dermatology, Course of Integrated Medicine; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Ichiro Katayama
- Department of Dermatology, Course of Integrated Medicine; Graduate School of Medicine; Osaka University; Osaka Japan
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10
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Faria PCPD, Cruz CC, Abulafia LA, Maceira JMP, Cassia FDF, Medeiros PM. The importance of direct immunofluorescence in pemphigus herpetiformis diagnosis. An Bras Dermatol 2018; 92:145-147. [PMID: 29267475 PMCID: PMC5726706 DOI: 10.1590/abd1806-4841.20174510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/16/2016] [Indexed: 01/28/2023] Open
Abstract
Pemphigus herpetiformis is an autoimmune bullous disease, that combines clinical
features of dermatitis herpetiformis and linear IgA bullous dermatosis and
immunological characteristics of pemphigus, which makes this disease peculiar
and this diagnosis rarely suspected in the first evaluation of the patient. The
reported case is of a patient with clinically bullous disease similar to
dermatitis herpetiformis, whose multiple biopsies were inconclusive, and only
after direct immunofluorescence with a pemphigus pattern (intraepidermal
intercellular pattern) the confirmation of the diagnosis was possible.
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Affiliation(s)
- Paula Carolina Pessanha de Faria
- Dermatology Outpatient Clinic of the Department of Dermatology of the Universidade do Estado do Rio de Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
| | - Camila Caberlon Cruz
- Dermatology Outpatient Clinic of the Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro - Rio De Janeiro (RJ), Brazil
| | - Luna Azulay Abulafia
- Dermatology Outpatient Clinic of the Department of Dermatology of the Universidade do Estado do Rio de Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil.,Dermatology Outpatient Clinic of the Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro - Rio De Janeiro (RJ), Brazil
| | - Juan Manuel Pineiro Maceira
- Pigmented Lesions Outpatient Clinic of the Department of Dermatology of the Universidade do Estado do Rio de Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
| | - Flávia de Freire Cassia
- Dermatology Outpatient Clinic of the Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro - Rio De Janeiro (RJ), Brazil
| | - Paula Mota Medeiros
- Dermatology Outpatient Clinic at Hospital do Açúcar de Alagoas do Centro Universitário Tiradentes, Maceió, Alagoas (AL), Brazil
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11
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Maggiore R, Viglizzo G, Occella C, Bleidl D, Coccia MC, Manunza F. Pemphigus herpetiformis resistant to first line therapy: a rare case in childhood. GIORN ITAL DERMAT V 2018; 154:499-501. [PMID: 29368854 DOI: 10.23736/s0392-0488.18.05816-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rosario Maggiore
- Department of Pediatrics, G. Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Gianmaria Viglizzo
- Unit of Dermatology, Department of Surgery and Intensive Care, IRCCS G. Gaslini Children's Hospital, Genoa, Italy
| | - Corrado Occella
- Unit of Dermatology, Department of Surgery and Intensive Care, IRCCS G. Gaslini Children's Hospital, Genoa, Italy
| | - Dario Bleidl
- Unit of Dermatology, Department of Surgery and Intensive Care, IRCCS G. Gaslini Children's Hospital, Genoa, Italy
| | - Maria C Coccia
- Unit of Pathology, Department of Translational Research, Laboratory Medicine, Diagnostics and Services, IRCCS G. Gaslini Children's Hospital, Genoa, Italy
| | - Francesca Manunza
- Unit of Dermatology, Department of Surgery and Intensive Care, IRCCS G. Gaslini Children's Hospital, Genoa, Italy -
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12
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Peterman CM, Vadeboncoeur S, Schmidt BA, Gellis SE. Pediatric Pemphigus Herpetiformis: Case Report and Review of the Literature. Pediatr Dermatol 2017; 34:342-346. [PMID: 28523900 DOI: 10.1111/pde.13152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pemphigus herpetiformis (PH) is a rare autoimmune bullous condition usually seen in adults and likely underrecognized in children. We describe a 2-year-old girl who presented with a chronic, generalized, blistering rash consistent with pediatric PH based on histology and immunohistochemistry and review the literature. Prognosis is generally more favorable in children than adults. Prednisone and dapsone should be considered as first-line agents to induce remission.
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Affiliation(s)
- Caitlin M Peterman
- Tufts University, School of Medicine, Boston, Massachusetts.,Dermatology Program, Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophie Vadeboncoeur
- Dermatology Program, Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Birgitta A Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen E Gellis
- Dermatology Program, Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Ansai O, Shimomura Y, Fujimoto A, Sakai A, Tsuchida Y, Hayashi R, Shigehara Y, Hama N, Abe R. Case of pemphigus herpetiformis with immunoglobulin G autoantibodies against desmocollin-3. J Dermatol 2017; 44:104-105. [PMID: 27177601 DOI: 10.1111/1346-8138.13451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Osamu Ansai
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yutaka Shimomura
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Atsushi Fujimoto
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akari Sakai
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuko Tsuchida
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryota Hayashi
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yohya Shigehara
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Natsumi Hama
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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14
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Galvañ-Pérez del Pulgar J, Tercedor-Sánchez J, Jiménez-Gallo D, Linares-Barrios M. Pénfigo herpetiforme con anticuerpos anti-desmogleína 1 y 3. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:785-786. [DOI: 10.1016/j.ad.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/29/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022] Open
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15
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Pemphigus Herpetiformis With Autoantibodies to Desmoglein 1 and 3. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Ishii K. Importance of serological tests in diagnosis of autoimmune blistering diseases. J Dermatol 2016; 42:3-10. [PMID: 25558946 DOI: 10.1111/1346-8138.12703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 01/07/2023]
Abstract
Autoimmune blistering diseases are organ-specific autoimmune diseases characterized by autoantibodies against structural proteins that maintain cell-cell (pemphigus diseases) and cell-matrix adhesions (pemphigoid diseases) in the skin and mucous membranes. Over the last few decades, identification of autoantigens and extensive characterization of autoantibodies have improved understanding of the pathogenesis of these diseases. In addition, the development of new sensitive and specific immunoassays enabled accurate diagnosis and proper evaluation of disease activity in autoimmune blistering diseases. In this review, we describe practical updates for molecular diagnostic tests for autoimmune blistering diseases and the basis for interpreting the results of the assays.
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Affiliation(s)
- Ken Ishii
- Department of Dermatology, Toho University Omori Medical Center, Tokyo, Japan
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17
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Pérez-Prieto I, Tirado-Sánchez A, Fierro-Arias L. Pemphigus herpetiformis: Case report. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Schoch JJ, Boull CL, Camilleri MJ, Tollefson MM, Hook KP, Polcari IC. Transplacental Transmission of Pemphigus Herpetiformis in the Setting of Maternal Lymphoma. Pediatr Dermatol 2015. [PMID: 26212699 DOI: 10.1111/pde.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pemphigus herpetiformis (PH) is characterized by grouped vesicular or papular pruritic lesions with histologic and immunopathologic features of pemphigus. PH can manifest at any age, and paraneoplastic cases have been reported. We describe a healthy boy born with acral crateriform erosions of the hands and feet whose 35-year-old mother had similar lesions. Biopsies from both patients were most consistent with PH. The mother was diagnosed with high-grade B-cell non-Hodgkin lymphoma and began chemotherapy with dexamethasone, and her lesions quickly improved. The infant had no additional lesions after 3 weeks of age and his acral erosions healed. To our knowledge, this is the first report of a diagnosis of PH in an infant and the first case of transplacental transmission of PH. This is also the first report of paraneoplastic PH in lymphoma. This case adds to the growing differential diagnosis of skin disease in postpartum women and their neonates.
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Affiliation(s)
| | - Christina L Boull
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Michael J Camilleri
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Kristen P Hook
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Ingrid C Polcari
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
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19
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On H, Hashimoto T, Kim SC. Pemphigus herpetiformis with IgG autoantibodies to desmoglein 1 and desmocollin 1. Br J Dermatol 2015; 172:1144-6. [DOI: 10.1111/bjd.13419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H.R. On
- Department of Dermatology and Cutaneous Biology Research Institute; Gangnam Severance Hospital; Yonsei University College of Medicine; Eonjuro 712, Gangnam-gu 135-720 Seoul Korea
| | - T. Hashimoto
- Department of Dermatology; Kurume University School of Medicine; Kurume University Institute of Cutaneous Cell Biology; Fukuoka Japan
| | - S.-C. Kim
- Department of Dermatology and Cutaneous Biology Research Institute; Gangnam Severance Hospital; Yonsei University College of Medicine; Eonjuro 712, Gangnam-gu 135-720 Seoul Korea
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20
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Laws PM, Heelan K, Al-Mohammedi F, Walsh S, Shear NH. Pemphigus herpetiformis: a case series and review of the literature. Int J Dermatol 2015; 54:1014-22. [DOI: 10.1111/ijd.12582] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Philip M. Laws
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Kara Heelan
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | | | - Scott Walsh
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Neil H. Shear
- Department of Medicine; University of Toronto; Toronto Ontario Canada
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21
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[Pemphigus herpetiformis]. Ann Dermatol Venereol 2014; 141:646-7. [PMID: 25288073 DOI: 10.1016/j.annder.2014.04.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/12/2014] [Accepted: 04/07/2014] [Indexed: 11/20/2022]
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22
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Porro AM, Caetano LDVN, Maehara LDSN, Enokihara MMDS. Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus. An Bras Dermatol 2014; 89:96-106. [PMID: 24626654 PMCID: PMC3938360 DOI: 10.1590/abd1806-4841.20142459] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022] Open
Abstract
The pemphigus group comprises the autoimmune intraepidermal blistering diseases
classically divided into two major types: pemphigus vulgaris and pemphigus
foliaceous. Pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and
IgG/IgA pemphigus are rarer forms that present some clinical, histological and
immunopathological characteristics that are different from the classical types. These
are reviewed in this article. Future research may help definitively to locate the
position of these forms in the pemphigus group, especially with regard to pemphigus
herpetiformis and the IgG/ IgA pemphigus.
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Affiliation(s)
- Adriana Maria Porro
- Federal University of São Paulo, Paulista School of Medicine, Dermatology Department, São PauloSP, Brazil, Dermatologist. Masters Degree and PhD . Adjunct Professor and Coordinator of Bullous Dermatosis at the Dermatology Department, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) - São Paulo (SP), Brazil
| | - Livia de Vasconcelos Nasser Caetano
- Federal University of São Paulo, Paulista School of Medicine, Dermatology Department, São PauloSP, Brazil, Dermatologist with specialization in Bullous Dermatosis at the Dermatology Department, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) - São Paulo (SP), Brazil
| | - Laura de Sena Nogueira Maehara
- Federal University of São Paulo, Paulista School of Medicine, Dermatology Department, Dermatologist with specialization in Bullous Dermatosis and Pediatric Dermatology at the Dermatology Department, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP). PhD-candidate at UNIFESP (Translational Medicine) and the University of Groningen (Center for Blistering Diseases, Groningen University Medical Center, Netherlands)
| | - Milvia Maria dos Santos Enokihara
- Federal University of São Paulo, Paulista School of Medicine, Dermatology and Pathology Departments, São PauloSP, Brazil, Pathologist. Masters Degree and PhD. Dermatopathologist at the Dermatology and Pathology Departments, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) - São Paulo (SP), Brazil
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23
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Nakamura Y, Takahata H, Teye K, Ishii N, Hashimoto T, Muto M. A case of pemphigus herpetiformis-like atypical pemphigus with IgG anti-desmocollin 3 antibodies. Br J Dermatol 2014; 171:1588-90. [DOI: 10.1111/bjd.13088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Y. Nakamura
- Department of Dermatology; Yamaguchi University Graduate School of Medicine; 1-1-1 Minami-Kogushi Ube 755-8505 Yamaguchi Japan
| | - H. Takahata
- Department of Dermatology; Yamaguchi Red Cross Hospital; Yamaguchi Japan
| | - K. Teye
- Department of Dermatology; Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology; Kurume Japan
| | - N. Ishii
- Department of Dermatology; Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology; Kurume Japan
| | - T. Hashimoto
- Department of Dermatology; Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology; Kurume Japan
| | - M. Muto
- Department of Dermatology; Yamaguchi University Graduate School of Medicine; 1-1-1 Minami-Kogushi Ube 755-8505 Yamaguchi Japan
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Yoshimura K, Ishii N, Hamada T, Abe T, Ono F, Hashikawa K, Fukuda S, Ohyama B, Koga H, Sogame R, Teye K, Ochiai T, Nakajima H, Nakajima K, Iijima S, Kanzaki M, Kojima K, Nagatani T, Fujimoto W, Karashima T, Nakama T, Ohata C, Furumura M, Tsuruta D, Hashimoto T. Clinical and immunological profiles in 17 Japanese patients with drug‐induced pemphigus studied at Kurume University. Br J Dermatol 2014; 171:544-53. [DOI: 10.1111/bjd.12925] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K. Yoshimura
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - N. Ishii
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - T. Hamada
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - T. Abe
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - F. Ono
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - K. Hashikawa
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - S. Fukuda
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - B. Ohyama
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - H. Koga
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - R. Sogame
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - K. Teye
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - T. Ochiai
- Department of Dermatology Surugadai Nihon University Hospital Tokyo Japan
| | - H. Nakajima
- Department of Dermatology Kochi University School of Medicine Kochi Japan
| | - K. Nakajima
- Department of Dermatology Kochi University School of Medicine Kochi Japan
| | - S. Iijima
- Department of Dermatology Mito Saiseikai General Hospital Mito Ibaraki Japan
| | - M. Kanzaki
- Department of Dermatology Mito Saiseikai General Hospital Mito Ibaraki Japan
| | - K. Kojima
- Department of Dermatology Kanazawa Medical University School of Medicine Ishikawa Japan
| | - T. Nagatani
- Department of Dermatology Hachioji Medical Center of Tokyo Medical University Tokyo Japan
| | - W. Fujimoto
- Department of Dermatology Kawasaki Medical School of Medicine Okayama Japan
| | - T. Karashima
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - T. Nakama
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - C. Ohata
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - M. Furumura
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
| | - D. Tsuruta
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
- Department of Dermatology Osaka City University Graduate School of Medicine Osaka Japan
| | - T. Hashimoto
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0011 Japan
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25
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Kitajima Y. 150(th) anniversary series: Desmosomes and autoimmune disease, perspective of dynamic desmosome remodeling and its impairments in pemphigus. ACTA ACUST UNITED AC 2014; 21:269-80. [PMID: 25078507 DOI: 10.3109/15419061.2014.943397] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Desmosomes are the most important intercellular adhering junctions that adhere two adjacent keratinocytes directly with desmosomal cadherins, that is, desmogleins (Dsgs) and desmocollins, forming an epidermal sheet. Recently, two cell-cell adhesion states of desmosomes, that is, "stable hyper-adhesion" and "dynamic weak-adhesion" conditions have been recognized. They are mutually reversible through cell signaling events involving protein kinase C (PKC), Src and epidermal growth factor receptor (EGFR) during Ca(2+)-switching and wound healing. This remodeling is impaired in pemphigus vulgaris (PV, an autoimmune blistering disease), caused by anti-Dsg3 antibodies. The antibody binding to Dsg3 activates PKC, Src and EGFR, linked to generation of dynamic weak-adhesion desmosomes, followed by p38MAPK-mediated endocytosis of Dsg3, resulting in the specific depletion of Dsg3 from desmosomes and acantholysis. A variety of pemphigus outside-in signaling may explain different clinical (non-inflammatory, inflammatory, and necrolytic) types of pemphigus. Pemphigus could be referred to a "desmosome-remodeling disease involving pemphigus IgG-activated outside-in signaling events".
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Affiliation(s)
- Yasuo Kitajima
- Department of Dermatology, Kizawa Memorial Hospital, Professor Emeritus Gifu University School of Medicine , Minokamo City, Gifu Prefecture , Japan
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Fuentes-Finkelstein P, Barnadas M, Gelpi C, Puig L. Pemphigus Herpetiformis With Progression to Pemphigus Foliaceus: A Case Report. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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27
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Fuentes-Finkelstein P, Barnadas M, Gelpi C, Puig L. Pemphigus herpetiformis with progression to pemphigus foliaceus: a case report. ACTAS DERMO-SIFILIOGRAFICAS 2013; 105:526-8. [PMID: 24168913 DOI: 10.1016/j.ad.2013.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - M Barnadas
- Servicio Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C Gelpi
- Servicio de Inmunología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - L Puig
- Servicio Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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28
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Ueda A, Ishii N, Teye K, Dainichi T, Ohyama B, Hamada T, Tsuruta D, Kamioka N, Mitsui K, Hosaka H, Soh I, Nakada T, Hashimoto T. Unique herpetiform bullous dermatosis with IgG antibodies to desmocollins 1/3 and LAD-1. Br J Dermatol 2013; 169:719-21. [PMID: 23607807 DOI: 10.1111/bjd.12398] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Ueda
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
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29
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Ohata C, Koga H, Teye K, Ishii N, Hamada T, Dainichi T, Furumura M, Sato M, Sueki H, Hashimoto T. Concurrence of bullous pemphigoid and herpetiform pemphigus with IgG antibodies to desmogleins 1/3 and desmocollins 1-3. Br J Dermatol 2012; 168:879-81. [DOI: 10.1111/bjd.12019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Bangash HK, Patel S, Soltani K, Shea CR, Sethi A. Blistering eruption on the chest of a 30-year-old pregnant woman. Int J Dermatol 2012; 51:1429-31. [PMID: 23171009 DOI: 10.1111/j.1365-4632.2012.05636.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haider K Bangash
- Section of Dermatology, University of Chicago Medical Center, IL, USA.
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31
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Pemphigus herpetiformis: Report of a rare case. J Am Acad Dermatol 2012; 67:e231-3. [DOI: 10.1016/j.jaad.2012.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/12/2012] [Accepted: 04/14/2012] [Indexed: 11/18/2022]
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Abstract
Pemphigus is an autoimmune bullous disease, in which autoantibodies react with the cell–cell adhesion structures, desmosomes, causing blisters and erosions on the oral mucosa and skin. Pemphigus is divided into two major subtypes: pemphigus vulgaris and pemphigus foliaceus. Oral corticosteroids are the primary treatment modality for pemphigus, while other therapeutic options, such as steroid pulse therapy, immunosuppressants, intravenous immunoglobulins, plasmapheresis and anti-CD20 monoclonal antibody therapy, are occasionally employed. Immunosuppressants used to treat pemphigus include azathioprine, cyclophosphamide, cyclosporine, mycophenolate mofetil and mizoribine. In this review, we summarize the current concepts of immunotherapy for the treatment of pemphigus in the Japanese population.
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Affiliation(s)
- Daisuke Tsuruta
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Hashimoto
- >Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
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33
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Ohyama B, Nishifuji K, Chan PT, Kawaguchi A, Yamashita T, Ishii N, Hamada T, Dainichi T, Koga H, Tsuruta D, Amagai M, Hashimoto T. Epitope spreading is rarely found in pemphigus vulgaris by large-scale longitudinal study using desmoglein 2-based swapped molecules. J Invest Dermatol 2012; 132:1158-68. [PMID: 22277941 DOI: 10.1038/jid.2011.448] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epitope spreading is involved in inducing and maintaining self-reactivity. Epitope spreading in pemphigus vulgaris (PV), caused by IgG autoantibodies to desmoglein 3 (Dsg3) and Dsg1, was previously analyzed using Dsg3/Dsg1 extracellular domain-swapped molecules. However, precise identification of the responsible epitopes in each molecule by using only this method was problematic. In this study, we studied epitope spreading in PV by a novel immunoprecipitation-immunoblot method using Dsg3 (or Dsg1)/Dsg2 domain-swapped molecules, which overcomes the problems associated with the previous approaches. We analyzed the antigenic epitopes recognized by 212 sera collected from 53 PV patients at multiple disease stages. The major epitopes were present at the N-terminal region of Dsgs and were unchanged over the course of the disease in both anti-Dsg3 mucosal dominant-type PV and anti-Dsg3/Dsg1 mucocutaneous-type PV. These N-terminal epitopes were calcium dependent. Circulating antibodies in paraneoplastic pemphigus and pemphigus herpetiformis had unique epitope distributions, although the Dsg N-termini still contained the major epitopes. These results suggest that, after onset, intramolecular and intermolecular epitope spreading among extracellular domains on Dsg3 and Dsg1 is rare in PV and has no correlation with disease course.
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Affiliation(s)
- Bungo Ohyama
- Department of Dermatology, Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
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Tateishi C, Tsuruta D, Nakanishi T, Uehara S, Kobayashi H, Ishii M, Hashimoto T. Antidesmocollin-1 antibody–positive, antidesmoglein antibody–negative pemphigus herpetiformis. J Am Acad Dermatol 2010; 63:e8-10. [DOI: 10.1016/j.jaad.2009.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 09/08/2009] [Accepted: 09/14/2009] [Indexed: 10/19/2022]
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35
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Mehta V, Balachandran C, Nayak S. Herpetiform pemphigus clinically resembling bullous pemphigoid. Indian J Dermatol 2010; 53:158-9. [PMID: 19882023 PMCID: PMC2763728 DOI: 10.4103/0019-5154.43218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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NAKASHIMA H, FUJIMOTO M, WATANABE R, ISHIURA N, YAMAMOTO AI, HASHIMOTO T, TAMAKI K. Herpetiform pemphigus without anti-desmoglein 1/3 autoantibodies. J Dermatol 2010; 37:264-8. [DOI: 10.1111/j.1346-8138.2009.00786.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Chan PT, Ohyama B, Nishifuji K, Yoshida K, Ishii K, Hashimoto T, Amagai M. Immune response towards the amino-terminus of desmoglein 1 prevails across different activity stages in nonendemic pemphigus foliaceus. Br J Dermatol 2010; 162:1242-50. [PMID: 20163417 DOI: 10.1111/j.1365-2133.2010.09696.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pemphigus foliaceus (PF) is a blistering skin disease mediated by antibodies to desmoglein (Dsg) 1. The two major subtypes are nonendemic and endemic PF. A previous study in endemic PF demonstrated that changes in antibody epitope could modulate disease relapse and remission. OBJECTIVES To characterize the frequency of immunoreactivity to various Dsg1 extracellular (EC) domains in nonendemic PF and to study if there is any change in epitope profile across various activity stages. METHODS Sera from 34 patients with nonendemic PF were selected. To map the conformational epitopes by immunoprecipitation-immunoblotting, we constructed five Dsg1/Dsg2 domain-swapped molecules, with each molecule representing one EC domain of Dsg1 on a backbone of Dsg2. RESULTS Dsg1 EC1, EC2, EC3, EC4 and EC5 domains were recognized by 88%, 50%, 13%, 22% and 0% of active PF sera, respectively. Immunoreactivity to EC3 or EC4 often cosegregated with that to either EC1 or EC2. Longitudinal follow-up of 21 patients with PF for a median of 16 months revealed that, in most cases, immunoreactivity to the amino-terminus of Dsg1 persisted across various activity stages; only two patients lost their EC1 reactivity upon remission and changed their major epitope(s) to EC2 ± EC3. CONCLUSIONS Most of the anti-Dsg1 antibodies in nonendemic PF bind to the amino-terminus of Dsg1, a region critical for intercellular adhesion of cadherins, and this skewed amino-terminal immunoreactivity prevails across various activity stages in most patients, even upon remission. These findings are valuable for understanding the biology of Dsg-mediated cellular adhesion as well as for the development of epitope-based monitoring and therapeutic strategies.
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Affiliation(s)
- P T Chan
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Miura T, Kawakami Y, Oyama N, Ohtsuka M, Suzuki Y, Ohyama B, Hashimoto T, Motoki Y, Yamamoto T. A case of pemphigus herpetiformis with absence of antibodies to desmogleins 1 and 3. J Eur Acad Dermatol Venereol 2010; 24:101-3. [DOI: 10.1111/j.1468-3083.2009.03331.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Lebeau S, Müller R, Masouyé I, Hertl M, Borradori L. Pemphigus herpetiformis: analysis of the autoantibody profile during the disease course with changes in the clinical phenotype. Clin Exp Dermatol 2009; 35:366-72. [PMID: 19874319 DOI: 10.1111/j.1365-2230.2009.03525.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pemphigus herpetiformis (PH) is a rare dapsone-responsive variant of pemphigus, characterized by annular and vesiculopustular cutaneous lesions. Most PH serum samples contain autoantibodies against desmoglein (Dsg)1, but not Dsg3, and the presence of the latter is almost invariably associated with mucosal involvement, as predicted based on the 'Dsg compensation theory'. METHODS We describe a patient with features characteristic of PH with histologically eosinophilic spongiosis who repeatedly tested positive for anti-Dsg3 but not anti-Dsg1 autoantibodies by ELISA. To investigate whether the peculiar clinical phenotype was due to a distinct immunological profile, the patient's serum was tested by ELISA and immunoblotting using recombinant forms of Dsg3. RESULTS Serum samples were found to have low and high reactivity against the EC1 and the EC4 domains of Dsg3, respectively, whereas the autoantibodies belonged predominantly to the IgG1 and IgG4 subclasses. The overall immunological profile was typical of pemphigus vulgaris. The patient finally developed isolated oral erosions 22 months after initial presentation, without significant changes in the autoantibody profile and of the targeted antigenic sites. CONCLUSIONS Our patient presented features characteristic of PH. Although circulating anti-Dsg3 antibodies were present, the patient had only cutaneous involvement for a long period. Our findings indicate that the proposed Dsg compensation theory cannot always explain the clinical phenotype, changes in which may occur without apparent modification of the autoantibody profile and antibody specificity. Hence, additional factors, such as Fcgamma-dependent neutrophil activation, may critically affect the clinical presentation of pemphigus.
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Affiliation(s)
- S Lebeau
- Department of Dermatology, University Hospital, Geneva, Switzerland
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40
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Ishii N, Maeyama Y, Karashima T, Nakama T, Kusuhara M, Yasumoto S, Hashimoto T. Immunoserological analyses of 55 patients with pemphigus at the Dermatological Department of Kurume University Hospital: an 11-year retrospective study (1996-2006). Int J Dermatol 2008; 47:1321-2. [DOI: 10.1111/j.1365-4632.2008.03712.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Khaled A, Gargouri A, Moula H, Fazaa B, Kamoun MR. [Diffuse pruritic eruption]. Ann Dermatol Venereol 2008; 135:512-5. [PMID: 18598808 DOI: 10.1016/j.annder.2007.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 11/23/2007] [Indexed: 11/26/2022]
Affiliation(s)
- A Khaled
- Service de dermatologie, hôpital Charles-Nicolle de Tunis, Tunis, Tunisie.
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44
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Kitajima Y, Aoyama Y. A perspective of pemphigus from bedside and laboratory-bench. Clin Rev Allergy Immunol 2008; 33:57-66. [PMID: 18094947 DOI: 10.1007/s12016-007-0036-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pemphigus represents a distinct organ-specific acquired autoimmune disease characterized by intra-epidermal blistering, which is induced by autoantibodies against desmosomal cadherins, desmoglein 1 (Dsg1), and Dsg3. Pemphigus is currently divided into three distinct varieties, i.e., pemphigus vulgaris (PV), pemphigus foliaceus (PF) and other variants of pemphigus (mostly associated with inflammation), depending on clinical features, the level of separation in the epidermis, and immunologic characteristics of auto-antigens. Blistering pathomechanisms differ for each of the types of pemphigus. Pemphigus, which results from autoantibodies against desmogleins and possibly to other proteins, binds to the cell surface antigens. This binding may cause steric hindrance to homophilic adhesion of desmogleins, and may, in turn, lead to internalization of desmogleins and inhibition of desmogleins' integration into desmosomes, resulting in the formation of Dsg3-depleted desmosomes in PV or Dsg1-depleted desmosomes in PF. Furthermore, PV-IgG activates an "outside-in" signaling pathway to induce disassembly of desmosomal components from the inside of the cells by phosphorylation of proteins, including Dsg3. On the other hand, Pemphigus-IgG-augmented signaling pathways may be linked to the secretion of cytokines such as in case of pemphigus herpetiformis and chemokines that initiate or activate inflammation. In this article, the classification of pemphigus and the characteristic pathomechanisms for acantholysis will be reviewed, with particular emphasis on the molecular and biochemical cell biology of these diseases.
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Affiliation(s)
- Yasuo Kitajima
- Department of Dermatology, Gifu University School of Medicine, Gifu City, Japan.
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Mihai S, Sitaru C. Immunopathology and molecular diagnosis of autoimmune bullous diseases. J Cell Mol Med 2007; 11:462-81. [PMID: 17521373 PMCID: PMC3922353 DOI: 10.1111/j.1582-4934.2007.00033.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 03/05/2007] [Indexed: 11/26/2022] Open
Abstract
Autoimmune bullous diseases are associated with autoimmunity against structural components maintaining cell-cell and cell matrix adhesion in the skin and mucous membranes. Pemphigus diseases are characterized by autoantibodies against the intercellular junctions and intraepithelial blisters. In pemphigoid diseases and epidermolysis bullosa acquisita, sub-epidermal blistering is associated with autoantibodies targeting proteins of the hemidesmosomal anchoring complex. The autoantigens in autoimmune blistering diseases have been extensively characterized over the past three decades. In general, the pathogenicity of autoantibodies, already suggested by clinical observations, has been conclusively demonstrated experimentally. Detection of tissue-bound and circulating serum autoantibodies and characterization of their molecular specificity is mandatory for the diagnosis of autoimmune blistering diseases. For this purpose, various immunofluorescence methods as well as immunoassays, including immunoblotting, enzyme-linked immunosorbent assay and immunoprecipitation have been developed. This review article describes the immunopathological features of autoimmune bullous diseases and the immunological and molecular tests used for their diagnosis and monitoring.
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Affiliation(s)
- Sidonia Mihai
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Cassian Sitaru
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Marzano AV, Tourlaki A, Cozzani E, Gianotti R, Caputo R. Pemphigus herpetiformis associated with prostate cancer. J Eur Acad Dermatol Venereol 2006; 21:696-8. [PMID: 17447995 DOI: 10.1111/j.1468-3083.2006.01992.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arranz D, Corral M, Prats I, López-Ayala E, Castillo C, Vidaurrázaga C, Díaz-Díaz R, Casado M. [Herpetiform pemphigus associated with esophageal carcinoma]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:119-21. [PMID: 16476349 DOI: 10.1016/s0001-7310(05)73050-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present the case of a 63-year-old woman with herpetiform pemphigus and disseminated esophageal carcinoma which began to manifest themselves simultaneously. Some cases of herpetiform pemphigus associated with neoplasms have previously been reported, but these have primarily been bronchopulmonary. The association of any type of pemphigus with esophageal cancer is very infrequent. We should be alert to the infrequent varieties of pemphigus and atypical bullous diseases, because they sometimes do not meet the diagnostic criteria of paraneoplastic pemphigus, but are the first manifestation of an underlying neoplasm.
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Affiliation(s)
- Dulce Arranz
- Servicio de Dermatología, Hospital La Paz, Po. de la Castellana 261, 28046 Madrid, Spain.
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Abstract
Pemphigus is an infrequent, organ-specific, autoimmune bullous disease, which affects the skin, mucous membranes and appendages. Histopathologically, it is characterized by acantholysis. Pemphigus has classically been divided into two major groups, pemphigus vulgaris and pemphigus foliaceus, with their respective clinical variants pemphigus vegetans and pemphigus erythematosus. In recent years, new variants of pemphigus have been described: paraneoplastic pemphigus, IgA pemphigus and pemphigus herpetiformis. This article reviews the epidemiology, etiopathogenesis, clinical symptoms, diagnosis, treatment and prognosis of pemphigus. Advances in molecular biology techniques have made it possible to more precisely identify the different antigens against which antibodies are directed, and to fine-tune ELISA diagnostic techniques. Treating pemphigus vulgaris and foliaceus with general steroids has modified their prognosis; it is estimated that mortality in recent decades is less than 10 %. Managing the clinical complications that appear during the evolution of the pemphigus has contributed to reducing morbidity and mortality.
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Takahashi H, Anzai H, Suzuki Y, Tanikawa A, Amagai M, Nishikawa T. Parallel fluctuation of anti-desmoglein 3 and anti-BP180 autoantibody titres in a patient with bullous pemphigoid. Clin Exp Dermatol 2004; 29:608-11. [PMID: 15550133 DOI: 10.1111/j.1365-2230.2004.01598.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a 73-year-old Japanese female who developed IgG autoantibodies against BP180 as well as desmoglein 3 (Dsg3). She showed tense blisters on the extremities without apparent mucosal involvement and a skin biopsy indicated subepidermal blisters with eosinophilic spongiosis. Her clinical and histologic features indicated the diagnosis of bullous pemphigoid while anti-Dsg3 IgG might not show an apparent pathogenic effect. Interestingly, titres of anti-Dsg3 IgG fluctuated in parallel with those of anti-BP180 IgG throughout the course with two flares. Although the exact mechanism for autoantibody production is still unknown, the close link in the production of IgG autoantibodies against two independent skin antigens suggests a shared immunoregulatory mechanism against cutaneous autoantigens.
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Affiliation(s)
- H Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
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Hisamatsu Y, Amagai M, Garrod DR, Kanzaki T, Hashimoto T. The detection of IgG and IgA autoantibodies to desmocollins 1-3 by enzyme-linked immunosorbent assays using baculovirus-expressed proteins, in atypical pemphigus but not in typical pemphigus. Br J Dermatol 2004; 151:73-83. [PMID: 15270874 DOI: 10.1111/j.1365-2133.2004.05995.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have shown previously that human desmocollin (Dsc) 1 is recognized by IgA autoantibodies of subcorneal pustular dermatosis (SPD) type IgA pemphigus. However, the presence of IgG anti-Dsc autoantibodies is still controversial, and antibodies to Dsc2 and Dsc3 have not been clearly identified. OBJECTIVES To investigate this by producing recombinant proteins consisting of the entire extracellular domains of human Dsc1, 2 and 3 in baculovirus, and to use them to establish an enzyme-linked immunosorbent assay (ELISA). METHODS By this ELISA, we examined in total 165 cases of various types of autoimmune bullous diseases, as well as 23 normal controls. RESULTS None of 45 sera of classical pemphigus showed either IgG or IgA antibodies to any Dsc. In contrast, one atypical pemphigus serum showed both IgG and IgA antibodies to Dsc1, which were adsorbed by incubation with Dsc1 baculoprotein. Furthermore, this ELISA detected both IgA and IgG anti-Dsc3 antibodies in one atypical case, and IgA antibodies to both Dsc2 and Dsc3 in another. This reactivity was confirmed by positive IgA immunofluorescence with Dsc2 and Dsc3 expressed on COS-7 cells. These results show that both IgG and IgA autoantibodies against all of Dsc1-3 are present in the sera of particular cases of nonclassical pemphigus, except for IgG antibodies to Dsc2, but that they are not detected in classical pemphigus. Unexpectedly, although IgA antibodies of all of eight SPD type IgA pemphigus sera reacted with Dsc1 expressed on COS-7 cells, only one serum was positive in Dsc1 ELISA for IgA. CONCLUSIONS This result indicates either that Dscs expressed by baculovirus may not adopt the correct conformation or that Dscs may need association with other molecules to express all the epitopes for autoantibodies.
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Affiliation(s)
- Y Hisamatsu
- Department of Dermatology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
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