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Riquelme-Mc Loughlin C, Mascaró JM. Treatment of pemphigoid gestationis with dupilumab. Clin Exp Dermatol 2021; 46:1578-1579. [PMID: 34048080 DOI: 10.1111/ced.14765] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Riquelme-Mc Loughlin
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J M Mascaró
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Abstract
Bullous diseases may be rare; however, this does not preclude the clinician from being familiar with their manifestations and treatment. After ruling out infection, genetically inherited blistering diseases are more likely to be the cause of blistering or erosions in the neonatal period, whereas immunobullous diseases are more common in adults. Published literature on immunobullous disorders reflects information gleaned from case reports and open-label case series; prospective studies and evidence-based treatments are limited. Although there may be overlapping clinical features, significant clinical differences exist between adults and children. Evidence-based treatment guidelines are limited, and information from the adult literature cannot be readily generalized to the pediatric population. This paper reviews the approach to blistering conditions and the differences among bullous pemphigoid, linear immunoglobulin A disease, dermatitis herpetiformis, pemphigus foliaceus, pemphigus vulgaris, and paraneoplastic pemphigus in adult versus pediatric patients.
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Affiliation(s)
- Kalyani Marathe
- Department of Dermatology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut School of Medicine, 21 South Road, Farmington, CT, 06032, USA
| | - Kimberly D Morel
- Departments of Dermatology & Pediatrics, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA.
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Soutou B, Aractingi S. Skin disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:732-40. [PMID: 25862358 DOI: 10.1016/j.bpobgyn.2015.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/26/2015] [Accepted: 03/06/2015] [Indexed: 11/19/2022]
Abstract
Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Universite saint-Joseph, 11-5076 Riad el Solh, Beirut, Lebanon; Centre Hospitalier du Nord, 100 Jdeidet Zgharta, Lebanon.
| | - Sélim Aractingi
- Faculté de médecine, Paris 5 descartes, Service de Dermatologie, Hôpital Cochin Tarnier, 89, rue d'Assas, 75006 Paris, France; Equipe Cellules souches foetales, Inserm UMR S 938 & UPMC, CDR St Antoine, 27, rue de Chaligny, 75012 Paris, France.
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Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis 2014; 9:136. [PMID: 25178359 PMCID: PMC4154519 DOI: 10.1186/s13023-014-0136-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Gestational pemphigoid (pemphigoid gestationis, PG) is a rare autoimmune skin disorder occurring characteristically during pregnancy. Autoantibodies against placental BP180 (also known as BPAG2 or collagen XVII) cause damage to the skin basement membrane, resulting in severe itching and blistering rash over the body and the extremities. The diagnosis of PG is confirmed by immunofluorescence analysis of a skin biopsy, while serum levels of pemphigoid antigen BP180 antibody can be used to assess disease activity. PG with mild symptoms can be treated with topical corticosteroids, while oral corticosteroids are the mainstay in treatment of severe PG. PG usually flares up at the time of delivery, and resolves spontaneously shortly after. However, relapses in subsequent pregnancies are common. As PG has been linked to the risk of prematurity and fetal growth restriction, prenatal monitoring jointly by a dermatologist and an obstetrician is recommended. Mothers should also be informed of the potential risk of re-activation of the disease in subsequent pregnancies and during hormonal contraception.
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Affiliation(s)
- Laura Huilaja
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaarin Mäkikallio
- />Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaisa Tasanen
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
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Noe MH, Messingham KA, Brandt DS, Andrews JI, Fairley JA. Pregnant women have increased incidence of IgE autoantibodies reactive with the skin and placental antigen BP180 (type XVII collagen). J Reprod Immunol 2010; 85:198-204. [PMID: 20471095 PMCID: PMC5242378 DOI: 10.1016/j.jri.2010.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/04/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
BP180 (type XVII collagen) is a transmembrane protein expressed in a variety of cell types. It is also the target of autoantibodies in cutaneous autoimmune disease including bullous pemphigoid and pemphigoid gestationis, a disease unique to pregnancy. The purpose of this study was to determine the prevalence and specificity of cutaneous autoantibodies in a cohort of pregnant women. De-identified sera were collected from pregnant women (n=299) and from non-pregnant controls (n=134). Sera were analyzed by ELISA for the presence of IgG and IgE autoantibodies directed against several cutaneous autoantigens. IgE antibodies against the NC16A domain of BP180 were detected in 7.7% of pregnant women, compared to 2.2% of healthy controls (p=0.01). No increase in total or cutaneous autoantigen specific IgG was seen. Total serum IgE was within the normal range. Full-length BP180 was detected by western immunoblot in epidermal, keratinocyte, placental and cytotrophoblast (CTB) cell lysates. Furthermore, flow cytometry and indirect immunofluorescence confirmed the expression of BP180 on the surface of cultured CTBs. Finally, it was demonstrated that IgE antibodies in the pregnancy sera labeled not only cultured CTBs, but also the placental amnion and cutaneous basement membrane zone using indirect immunofluorescence. We conclude that some pregnant women develop antibodies specific for BP180, and that these autoantibodies are capable of binding both CTB and the placental amnion, potentially affecting placental function.
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Affiliation(s)
- Megan H. Noe
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Debra S. Brandt
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
| | - Janet I. Andrews
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA
| | - Janet A. Fairley
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
- Department of Dermatology, VA Medical Center, Iowa City, IA 52242, USA
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Chi CC, Wang SH, Charles-Holmes R, Ambros-Rudolph C, Powell J, Jenkins R, Black M, Wojnarowska F. Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes. Br J Dermatol 2009; 160:1222-8. [DOI: 10.1111/j.1365-2133.2009.09086.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suárez-Fernández R, España-Alonso A, Herrero-González J, Mascaró-Galy J. Practical Management of the Most Common Autoimmune Bullous Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70288-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Regnier S, Fermand V, Levy P, Uzan S, Aractingi S. A case-control study of polymorphic eruption of pregnancy. J Am Acad Dermatol 2007; 58:63-7. [PMID: 17884242 DOI: 10.1016/j.jaad.2007.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 08/01/2007] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Polymorphic eruption of pregnancy (PEP) is a pruritic disease that usually occurs in primiparous women, most commonly in the last trimester of pregnancy. The origin and pathomechanisms still remain unknown. OBJECTIVES We attempted to determine the parameters that may be associated with or complicate the course of PEP. METHODS Data of 200 pregnant women (40 PEP and 160 control) were studied retrospectively and compared statistically using univariable and multivariable analysis. RESULTS In multivariate analysis, pregnancy with male fetuses (P = .02) and delivery by cesarean section (P = .012) were overrepresented in the PEP group. A tendency toward more multiple gestation pregnancy in PEP was found (P = .07). The risk of PEP was not related to excessive maternal or fetal weight gain. LIMITATIONS This was a retrospective study. CONCLUSION This large case-control study confirms the already suspected association of PEP with male fetuses and cesarean deliveries in multivariate analysis. The higher rate of multiple gestation pregnancy was also established.
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Affiliation(s)
- Stephanie Regnier
- Department of Dermatology, Hôpital Tenon (Assistance Publique-Hôpitaux de Paris), Unité de Formation et de Recherche Pierre et Marie Curie, Paris 6, Université Pierre et Marie Curie, Paris, France.
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Castro LA, Lundell RB, Krause PK, Gibson LE. Clinical experience in pemphigoid gestationis: Report of 10 cases. J Am Acad Dermatol 2006; 55:823-8. [PMID: 17052488 DOI: 10.1016/j.jaad.2006.07.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/11/2006] [Accepted: 07/18/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pemphigoid gestationis is a rare autoimmune blistering disease that occurs during pregnancy. OBJECTIVE This study reviewed our clinical experience with pemphigoid gestationis. METHODS We reviewed medical records of 10 patients with pemphigoid gestationis seen at Mayo Clinic, Rochester, Minnesota, between 1976 and 2004. RESULTS Urticarial papules were the most frequent clinical presentation followed by blisters and rash. Pruritus was the cardinal symptom. Lesions presented initially on the legs, thighs, back, and chest. Direct immunofluorescence had the highest diagnostic test sensitivity. Systemic corticosteroids were the mainstay of treatment. Fetal and maternal outcome was good in all cases. LIMITATIONS This was a retrospective, single-institution study. CONCLUSIONS This condition can be easily confused with other dermatoses of pregnancy, for example, pruritic urticarial papules of pregnancy. Biopsy for direct immunofluorescence is the preferred test for confirmation of diagnosis. On the basis of good patient outcomes, conservative treatment seems warranted.
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Affiliation(s)
- Luis A Castro
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Herpes gestationis (penfigoide gestacional). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77304-9] [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]
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Affiliation(s)
- D M Paternoster
- Department of Obstetrics and Gynecology, Padova University, Italy
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