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Dyshidrosiform Bullous Pemphigoid. ACTA ACUST UNITED AC 2021; 57:medicina57040398. [PMID: 33924249 PMCID: PMC8074754 DOI: 10.3390/medicina57040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
Dyshidrosiform bullous pemphigoid is a variant of bullous pemphigoid. At least 84 patients with dyshidrosiform bullous pemphigoid have been described. Dyshidrosiform bullous pemphigoid usually presents with pruritic blisters in elderly individuals; the hemorrhagic or purpuric lesions on the palms and soles can be the only manifestation of the disease. However, bullae may concurrently or subsequently appear on other areas of the patient's body. Patients typically improve after the diagnosis is established and treatment is initiated. The mainstay of therapy is systemic corticosteroids, with or without topical corticosteroids, and systemic dapsone or immunosuppressants. Drug-related or nickel-induced dyshidrosiform bullous pemphigoid improves after stopping the associated agent; however, systemic therapy has also been required to achieve resolution of the blisters. Similar to classic bullous pemphigoid, neurologic conditions and psychiatric disorders have been observed in dyshidrosiform bullous pemphigoid patients. The new onset of recurrent or persistent blisters on the palms, soles, or both of an elderly individual should prompt the clinician to consider the diagnosis of dyshidrosiform bullous pemphigoid.
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Merton A, Wu YH. Spongiform pemphigoid: A case series of an uncommon histopathologic pattern. J Cutan Pathol 2019; 47:339-345. [PMID: 31837162 DOI: 10.1111/cup.13627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/22/2019] [Accepted: 12/05/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Bullous pemphigoid is an autoimmune bullous disease characterized by subepidermal separation. We encountered cases of bullous pemphigoid confirmed by direct immunofluorescence study but demonstrating spongiotic dermatitis without subepidermal clefting. Many of them occurred in volar sites, mimicking dyshidrotic dermatitis. METHODS We retrospectively collected patients who were pathologically and/or immunopathologically diagnosed with bullous pemphigoid from 2002 to 2017. Patients who presented with prominent spongiosis without subepidermal clefting were included and compared with patients who were diagnosed with dyshidrotic dermatitis. RESULTS A total of nine cases of spongiform pemphigoid out of 385 bullous pemphigoid patients (2.3%) were identified and compared with 15 patients with dyshidrotic dermatitis. Average age of spongiform pemphigoid patients (76 years) was much older than that of the control group (34 years). Microvesicles in the mid- to lower epidermis (P < 0.001), eosinophils exocytosis (P < 0.001), and eosinophils microabscess (P < 0.001) in both the epidermis and papillary dermis were more common in spongiform pemphigoid. CONCLUSION Spongiform pemphigoid mimics spongiotic dermatitis may result in a pathological diagnostic pitfall. The presence of eosinophil microabscess and exocytosis in the epidermis and papillary dermis were important clues. Immunofluorescence studies should be conducted to confirm the diagnosis of bullous pemphigoid.
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Affiliation(s)
- Armand Merton
- College of Medicine, North Reclamation Area, Cebu Doctors' University Hospital, Mandaue City, Philippines
| | - Yu-Hung Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
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Basseri S, Ly TY, Hull PR. Dyshidrotic Bullous Pemphigoid: Case Report and Review of Literature. J Cutan Med Surg 2018; 22:614-617. [PMID: 29502439 DOI: 10.1177/1203475418763544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dyshidrotic pemphigoid (DP) is a rare variant of bullous pemphigoid (BP) that affects the hands and feet and may resemble an acute vesicular eczema. While it can remain confined to hands and feet, spread that involves the entire body is described. BP and DP are associated with autoantibodies directed against hemidesmosomal proteins BP180 (collagen XVII) and BP230 (dystonin), which are transmembrane and intracellular proteins in the basement membrane zone, respectively. CASE SUMMARY We present a case of DP in a 78-year-old woman who was diagnosed based on histopathologic and immunofluorescence findings and subsequently successfully treated. CONCLUSION DP is an unusual form of localized BP. While the pathogenesis is still unclear, it may involve differential expression of BP antigens in the cutaneous basement membrane of the hands and feet. The clinical presentation is a diagnostic challenge, and skin biopsies with immunofluorescence studies are required for diagnosis.
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Affiliation(s)
- Sana Basseri
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thai Yen Ly
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,2 Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | - Peter R Hull
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,3 Department of Medicine, Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, NS, Canada
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Michelerio A, Croci GA, Vassallo C, Brazzelli V. Hemorrhagic vesiculobullous eruption on the palms and the soles as presentation of dyshidrosiform bullous pemphigoid. JAAD Case Rep 2017; 4:61-63. [PMID: 29387751 PMCID: PMC5771739 DOI: 10.1016/j.jdcr.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, University of Pavia, Pavia, Italy
| | - Giorgio Alberto Croci
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Camilla Vassallo
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, University of Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, University of Pavia, Pavia, Italy
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Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease in Western countries, and typically affects the elderly. BP is immunologically characterized by tissue-bound and circulating autoantibodies directed against either the BP antigen 180 (BP180, or BPAG2) or the BP antigen 230 (BP230, or BPAG1e), or even both, which are components of hemidesmosomes involved in the dermal-epidermal cohesion. Risk factors for BP include old age, neurologic diseases (dementia, Parkinson's disease, cerebrovascular disease), and some particular drugs, including loop diuretics, spironolactone and neuroleptics. The spectrum of clinical presentations is extremely broad. Clinically, BP is an intensely pruritic erythematous eruption with widespread blister formation. In the early stages, or in atypical, non-bullous variants of the disease, only excoriated, eczematous or urticarial lesions (either localized or generalized) are present. The diagnosis of BP relies on immunopathologic findings, especially based on both direct and indirect immunofluorescence microscopy observations, as well as on anti-BP180/BP230 enzyme-linked immunosorbent assays (ELISAs). BP is usually a chronic disease, with spontaneous exacerbations and remissions, which may be accompanied by significant morbidity. In the past decade, potent topical corticosteroids have emerged as an effective and safe first-line treatment for BP, but their long-term feasibility is still controversial. Newer therapeutic agents targeting molecules involved in the inflammatory cascade associated with BP represent future alternatives to classical immunosuppressant drugs for maintenance therapy.
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Abstract
Bullous pemphigoid (BP) constitutes the most frequent autoimmune subepidermal blistering disease. It is associated with autoantibodies directed against the BP antigens 180 (BP180, BPAG2) and BP230 (BPAG1-e). The pathogenicity of anti-BP180 antibodies has been convincingly demonstrated in animal models. The clinical features of BP are extremely polymorphous. The diagnosis of BP critically relies on immunopathologic findings. The recent development of novel enzyme-linked immunosorbent assays has allowed the detection of circulating autoantibodies with relatively high sensitivity and specificity. Although potent topical steroids have emerged in the past decade as first-line treatment of BP, management of the disease may be challenging.
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Affiliation(s)
- Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy.
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Di Zenzo G, Marazza G, Borradori L. Bullous pemphigoid: physiopathology, clinical features and management. ADVANCES IN DERMATOLOGY 2007; 23:257-88. [PMID: 18159905 DOI: 10.1016/j.yadr.2007.07.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There has been a considerable progress in the understanding of the physiopathology of BP during the past 2 decades. The insights into the humoral and cellular immune response against BP180 and BP230 have increased significantly. Nevertheless, the factors underlying the initiation of the disease leading to a disruption of self-tolerance remain unclear. Clinically, the disease shows protean presentations, and diagnostic delay is common. A practical, relevant, and unresolved question is how to identify patients suffering from BP at an early stage of the disease, when direct immunofluorescence microscopy findings still may be negative. The characterization of markers allowing the differentiation of BP from other pruritic eruptions occurring in the elderly population would be extremely helpful in daily practice. Finally, despite the knowledge that potent topical steroids are efficient in controlling the disease, management of BP sometimes remains difficult and requires systemic therapies. It is hoped that a better knowledge of the regulation of the autoimmune response in BP also will facilitate the design of novel immunomodulatory therapeutic approaches devoid of the severe side effects of current immunosuppressive treatments.
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Affiliation(s)
- Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Via Monti di Creta 104, 00167 Rome, Italy.
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Sugimura C, Katsuura J, Moriue T, Matsuoka Y, Kubota Y. Dyshidrosiform pemphigoid: report of a case. J Dermatol 2003; 30:525-9. [PMID: 12928541 DOI: 10.1111/j.1346-8138.2003.tb00426.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2003] [Accepted: 04/15/2003] [Indexed: 11/29/2022]
Abstract
A Japanese woman had bullous eruptions on her palms and soles for two months, histopathologic examination, immunofluorescence microscopy, and ELISA for BP180 antigen led to the definitive diagnosis of dyshidrosiform pemphigoid (DP). This paper also includes a study of 15 other cases of DP.
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Affiliation(s)
- Chieko Sugimura
- Department of Dermatology, Faculty of Medicine, Kagawa Medical University, Kagawa 761-0793, Japan
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Knees-Matzen S, Proksch E, Meigel W. Dyshidrosiform bullous pemphigoid: trigger factors. J Eur Acad Dermatol Venereol 1996. [DOI: 10.1111/j.1468-3083.1996.tb00580.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Borradori L, Harms M. Podopompholyx due to pemphigus vulgaris and Trichophyton rubrum infection. Report of an unusual case. Mycoses 1994; 37:137-9. [PMID: 7845420 DOI: 10.1111/j.1439-0507.1994.tb00790.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the case of a 48-year old man who after a disease-free interval of 7 years developed a relapse of pemphigus vulgaris (PV) presenting as pompholyx of the left foot. The patient was first thought to suffer from a dyshidrosic form of tinea pedis due to Trichophyton rubrum. Although the concomitant occurrence of a dermatomycosis and PV has been described previously, our case illustrates an unusual and misleading presentation of PV, which may delay the correct diagnosis.
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Affiliation(s)
- L Borradori
- Department of Dermatology, Hôrital Cantonal Universitaire, Genève, Switzerland
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Affiliation(s)
- E Fonseca
- Department of Dermatology, Hospital La Paz, Madrid, Spain
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Affiliation(s)
- N Atakan
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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