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Criton S, Jose A, Abraham U. A case of IgA pemphigus in a five-year-old child. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2021. [DOI: 10.4103/ijdpdd.ijdpdd_122_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Karamova AE, Chikin VV, Znamenskaya LF, Nefedova MA, Mamedova ES. Pemphigus vegetans: A clinical case. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-2-55-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - L. F. Znamenskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - E. S. Mamedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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Lekić B, Gajić-Veljić M, Popadić S, Nikolić M. IgA Pemphigus in a Child – a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2017-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
IgA pemphigus (IGAP) is a rare autoimmune bullous disease characterized by IgA deposits on keratinocyte cell surfaces. The IGAP is classified into: 1) subcorneal pustular dermatosis (SPD) type, and 2) intraepidermal neutrophilic (IEN) IgA dermatosis type. So far, only 9 children with IGAP have been described in the literature, of whom only 3 with SPD type. We report a 3-year-old boy with SPD type of IGAP. Clinically, he presented with pruritic vesicles, pustules and erosions on the face, trunk, groin area, and extremities. Histopathology showed subcorneal pustules containing a few acantholytic cells. Direct immunofluorescence (DIF) test of Tzanck smear showed intercellular IgA deposits on the surface of the groups of epidermal cells. Oral dapsone and prednisone induced remission after two weeks; the treatment was discontinued 11 months later, and complete remission was achieved during 19 months without any treatment. Direct immunofluorescence of Tzanck smear is a simple, sensitive, rapid and non-aggressive test, very suitable for the diagnosis of IGAP in children.
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Affiliation(s)
- Branislav Lekić
- Clinic of Dermatovenereology , Clinical Center of Serbia , Belgrade , Republic of Serbia
| | - Mirjana Gajić-Veljić
- Clinic of Dermatovenereology , Clinical Center of Serbia , Belgrade , Republic of Serbia
- University of Belgrade , School of Medicine , Belgrade , Republic of Serbia
| | - Svetlana Popadić
- Clinic of Dermatovenereology , Clinical Center of Serbia , Belgrade , Republic of Serbia
- University of Belgrade , School of Medicine , Belgrade , Republic of Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology , Clinical Center of Serbia , Belgrade , Republic of Serbia
- University of Belgrade , School of Medicine , Belgrade , Republic of Serbia
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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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Geller S, Gat A, Zeeli T, Hafner A, Eming R, Hertl M, Sprecher E. The expanding spectrum of IgA pemphigus: a case report and review of the literature. Br J Dermatol 2014; 171:650-6. [PMID: 24601812 DOI: 10.1111/bjd.12940] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 12/01/2022]
Abstract
IgA pemphigus (IGAP) is a rare, distinct variant of pemphigus, currently classified, depending upon the histological features, immunofluorescence staining pattern and autoantibody profile, into two types: subcorneal pustular dermatosis (SPD) and intraepidermal neutrophilic IgA dermatosis. In a patient with a widespread blistering disease of the skin resembling SPD-type IGAP, we demonstrate the coexistence of IgA reactivity to both epidermal (desmocollins 2 and 3) and basement membrane-associated (BP180) proteins, suggesting the coexistence of atypical IGAP and linear IgA bullous dermatosis, respectively. This case, together with 20 previous reports of atypical IGAP, underscores the limitations of current classification schemes. Therefore, we suggest reclassifying these cases under the general term 'IGAP spectrum'.
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Affiliation(s)
- S Geller
- Department of Dermatology, Tel Aviv Sourasky Medical Center, 6, Weizmann Street, Tel Aviv, 64239, Israel
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de Oliveira JP, Gabbi TVB, Hashimoto T, Aoki V, Santi CG, Maruta CW, Rivitti EA, Reis VMS. Two Brazilian Cases of IgA Pemphigus. J Dermatol 2014; 30:886-91. [PMID: 14739515 DOI: 10.1111/j.1346-8138.2003.tb00343.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 08/26/2003] [Indexed: 11/29/2022]
Abstract
IgA pemphigus is a rare, neutrophilic, acantholytic skin disorder with approximately 70 cases described in the literature. We report two patients with the subcorneal pustular dermatosis (SPD) type of IgA pemphigus. Initially, both patients were misdiagnosed as subcorneal pustular dermatosis of Sneddon and Wilkinson. The correct diagnosis was only made after detecting intercellular IgA depositions in the epidermis by direct immunofluorescence. Immunoblotting (IB) of normal human epidermal extracts, performed on both sera, was negative for Dsg 1, Dsg 3, BP 230, BP 180, 210 kDa envoplakin, and 190 kDa periplakin. ELISA for desmogleins (Dsg 1 and Dsg 3) showed that neither of the cases had IgA antibodies to Dsg. The c-DNA transfection test for desmocollins (Dsc) revealed that the IgA antibodies of both patients reacted with desmocollin 1. This result supports the hypothesis that the autoantigen in SPD type IgA pemphigus is desmocollin 1.
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Asahina A, Koga H, Suzuki Y, Hashimoto T. IgA pemphigus associated with diffuse large B-cell lymphoma showing unique reactivity with desmocollins: unusual clinical and histopathological features. Br J Dermatol 2012; 168:224-6. [PMID: 22757612 DOI: 10.1111/j.1365-2133.2012.11127.x] [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: 11/29/2022]
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Zaraa I, Sellami A, Bouguerra C, Sellami M, Chelly I, Zitouna M, Makni S, Hmida A, Mokni M, Osman A. Pemphigus vegetans: a clinical, histological, immunopathological and prognostic study. J Eur Acad Dermatol Venereol 2010; 25:1160-7. [DOI: 10.1111/j.1468-3083.2010.03939.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Monshi B, Marker M, Feichtinger H, Schmid G, Kriehuber E, Födinger D, Rappersberger K. Pemphigus vegetans--immunopathological findings in a rare variant of pemphigus vulgaris. J Dtsch Dermatol Ges 2009; 8:179-83. [PMID: 19725838 DOI: 10.1111/j.1610-0387.2009.07214.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with painful erosions of the oral cavity and the labia minora developed multifocal blisters in inter-triginous areas. These blisters eroded and evolved into papillomatous erosive vegetations. Histopathology and immunopathological investigations confirmed the diagnosis of pemphigus vegetans, mediated by IgG autoantibodies. The circulating IgG1 and IgG4 autoantibodies were exclusively directed against desmoglein 3, as shown by ELISA and indirect immunofluorescence studies. These IgG1 and IgG4 isotypes were also in vivo bound, as demonstrated with immunoperoxidase staining of perilesional skin. Our clinical, biochemical and immunopathological observations confirm the hypothesis that pemphigus vegetans is a variant of pemphigus vulgaris.
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Affiliation(s)
- Babak Monshi
- Department of Dermatology and Venereology, Krankenanstalt Rudolfstiftung, Vienna, Austria.
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Morizane S, Yamamoto T, Hisamatsu Y, Tsuji K, Oono T, Hashimoto T, Iwatsuki K. Pemphigus vegetans with IgG and IgA antidesmoglein 3 antibodies. Br J Dermatol 2005; 153:1236-7. [PMID: 16307672 DOI: 10.1111/j.1365-2133.2005.06956.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Howell SM, Bessinger GT, Altman CE, Belnap CM. Rapid response of IgA pemphigus of the subcorneal pustular dermatosis subtype to treatment with adalimumab and mycophenolate mofetil. J Am Acad Dermatol 2005; 53:541-3. [PMID: 16112379 DOI: 10.1016/j.jaad.2005.02.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 02/23/2005] [Accepted: 02/27/2005] [Indexed: 10/25/2022]
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Bruckner AL, Fitzpatrick JE, Hashimoto T, Weston WL, Morelli JG. Atypical IgA/IgG pemphigus involving the skin, oral mucosa, and colon in a child: a novel variant of IgA pemphigus? Pediatr Dermatol 2005; 22:321-7. [PMID: 16060868 DOI: 10.1111/j.1525-1470.2005.22408.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immune-mediated blistering diseases are rare in childhood, with the subset of IgA pemphigus being extremely uncommon. A child with a bullous disorder of the oral mucosa, skin, and colon is reported because of the unusual nature of the clinical and laboratory findings. Immunofluorescence studies demonstrated both intercellular epidermal and basement membrane zone deposition of IgA and IgG antibodies, as well as intercellular colonic deposition of IgA antibodies. IgA and IgG ELISA tests were positive for desmoglein 3 as the intercellular epidermal antigen. The generation of multiple antibodies against several potential antigenic targets suggests epitope spreading may play a role in this disease. We believe this represents a novel variant of IgA pemphigus.
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Affiliation(s)
- Anna L Bruckner
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
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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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Abstract
IgA pemphigus is a rare autoimmune bullous disease characterized by IgA deposition at keratinocyte cell surfaces. Clinically and histologically, IgA pemphigus is divided into two major subtypes: subcorneal pustular dermatosis (SPD) type and intraepidermal neutrophilic IgA dermatosis (IEN) type. Using cDNA transfection and living cell immunofluorescence, we previously showed that desmocollin 1, one of the desmosomal cadherins, is the autoantigen in SPD-type IgA pemphigus, but the autoantigen in IEN type is still unclear. In the present study we investigated antigen localization by postembedding immunoelectron microscopy. We examined three sera each of SPD-type and IEN-type IgA pemphigus. In SPD-type, gold particles were observed predominantly in the extracellular spaces between keratinocytes at desmosomes, although a few particles were observed in the intracellular domain at the desmosomal attachment plaques. In IEN type, the gold particles were observed mainly in the intercellular spaces in nondesmosomal areas. These results provide evidence that the IgA in the sera of SPD-type IgA pemphigus reacts with the extracellular domain of desmocollins. In contrast, the autoantigen for IEN type may in fact not be a component of desmosomes. IEN-type IgA pemphigus may be the first member of the pemphigus group of autoimmune bullous dermatoses that reacts with a nondesmosomal transmembranous protein.
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Affiliation(s)
- N Ishii
- Department of Dermatology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
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Suzuki M, Karube S, Kobori Y, Usui K, Murata S, Kato H, Nakagawa H. IgA pemphigus occurring in a 1-month-old infant. J Am Acad Dermatol 2003; 48:S22-4. [PMID: 12582378 DOI: 10.1067/mjd.2003.119] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An 11-month-old girl had recurrent pruritic vesiculopustular lesions involving the trunk, extremities, and scalp since the age of 1-month. Histopathologic examination revealed an intraepidermal bulla produced by acantholysis and neutrophilic spongiosis. Direct immunofluorescence showed IgA deposits in the intercellular space throughout the epidermis. Circulating anti-intercellular IgA autoantibodies were absent. Dapsone therapy was effective.
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Affiliation(s)
- Masayuki Suzuki
- Department of Dermatology, Jichi Medical School, Yakushiji Minamikawachimachi Kawachigun Tochigi, Japan.
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Pénfigo IgA. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hashimoto T, Yasumoto S, Nagata Y, Okamoto T, Fujita S. Clinical, histopathological and immunological distinction in two cases of IgA pemphigus. Clin Exp Dermatol 2002; 27:636-40. [PMID: 12472534 DOI: 10.1046/j.1365-2230.2002.01061.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two cases of IgA pemphigus, one of the subcorneal pustular dermatosis (SPD) type and one of the intraepidermal neutrophilic IgA dermatosis (IEN) type, are described. IgA anti-keratinocyte cell surface antibodies reacted only with the uppermost epidermis in the SPD type but with the entire epidermis in the IEN type. A cDNA transfection test for desmocollins (Dsc) revealed that IgA antibodies of the SPD type reacted with Dsc1, but the IEN type did not react with any of the Dsc isoforms (Dsc1-3). ELISA for desmoglein 1 (Dsg1) and Dsg3 showed that neither of the cases had antibodies to Dsg - of either the IgG or IgA subtype. These results confirm that the autoantigen in SPD-type IgA pemphigus is Dsc1, whereas the antigen in most cases of IEN-type IgA pemphigus is unknown.
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Affiliation(s)
- T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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19
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Affiliation(s)
- T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan.
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20
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Brenner S, Mashiah J. Autoimmune blistering diseases in children: signposts in the process of evaluation. Clin Dermatol 2000; 18:711-24. [PMID: 11173206 DOI: 10.1016/s0738-081x(00)00154-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Brenner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Niimi Y, Kawana S, Kusunoki T. IgA pemphigus: a case report and its characteristic clinical features compared with subcorneal pustular dermatosis. J Am Acad Dermatol 2000; 43:546-9. [PMID: 10954673 DOI: 10.1067/mjd.2000.107478] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of IgA pemphigus. A 35-year-old woman had vesiculopustular eruptions on her scalp, trunk, and extremities. Histologic examination showed a subcorneal pustule containing numerous neutrophils without acantholysis. Direct immunofluorescence revealed IgA deposits in the intercellular space throughout the epidermis, more intense in superficial layers and less intense in lower layers. The titer of circulating IgA antibodies was 1:160 in normal human skin as a substrate. Skin lesions responded to dapsone. The IgA autoantibody from this patient did not react with desmogleins or desmocollins when immunoblotting, enzyme-linked immunosorbent assay, or complement DNA transfection was used. We consider the characteristic clinical features that favor the diagnosis of IgA pemphigus rather than classic subcorneal pustular dermatosis as follows: (1) the lesions involve the scalp and/or face, and (2) the distribution of the lesions is more widespread.
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Affiliation(s)
- Y Niimi
- Department of Dermatology, Nippon Medical School, and Kusunoki Dermatology Clinic, Tokyo, Japan
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Yasuda H, Kobayashi H, Hashimoto T, Itoh K, Yamane M, Nakamura J. Subcorneal pustular dermatosis type of IgA pemphigus: demonstration of autoantibodies to desmocollin-1 and clinical review. Br J Dermatol 2000; 143:144-8. [PMID: 10886149 DOI: 10.1046/j.1365-2133.2000.03604.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a 40-year-old Japanese man with a 3-year history of vesiculopustular lesions resembling subcorneal pustular dermatosis. Histopathology showed subcorneal pustules containing a few acantholytic cells, and direct immunofluorescence disclosed IgA deposition in the intercellular space of the upper epidermis. Circulating IgA autoantibodies of very low titre were also demonstrated by indirect immunofluorescence. A novel cDNA transfection technique clearly detected IgA autoantibodies reactive with human desmocollin-1. Combined therapy with dapsone and etretinate improved the skin lesions. We review the clinical features of 49 patients in the literature who presented with vesiculopustular lesions and intraepidermal IgA deposition.
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Affiliation(s)
- H Yasuda
- Department of Dermatology, Sapporo Social Insurance General Hospital, 2-1, 2-Jo, 6-Chome, Atsubetsu Chuo, Atsubetsu, Sapporo 004-8618, Japan
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Abstract
Immunobullous diseases are quite unusual in children. We report two children who developed immunobullous disease shortly after a second solid organ transplantation. One child had IgA pemphigus vegetans, the other bullous pemphigoid. We hypothesize that the repeat organ transplantation served as a "booster" immunization for autoantibody production. Both children developed their immunobullous condition while being treated with immunosuppressive drugs that are used to treat immunobullous disorders.
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Affiliation(s)
- J G Morelli
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
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24
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Abstract
Pemphigus describes a group of autoimmune diseases characterized by blisters and erosions of the skin and mucous membranes, acantholysis by histology, and autoantibodies directed against epidermal cell surface components. Since the early 1970s, the following new clinical variants of pemphigus have been reported: pemphigus herpetiformis, IgA pemphigus, and paraneoplastic pemphigus. In recent years, significant data have been obtained from laboratory investigation on these rare and atypical variants, especially regarding their specific target antigens. We review these variants, their clinical presentations, histologic findings, immunopathology, target antigens, theories of pathogenesis, treatment modalities, and clinical courses.
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Affiliation(s)
- N D Robinson
- Department of Dermatology, Northwestern University Medical School, Chicago, Illinois, USA
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25
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Nousari HC, Kimyai-Asadi A, Ketabchi N, Hughes M, Anhalt GJ. A patient with a refractory cutaneous bullous eruption. J Cutan Med Surg 1999; 3:201-4. [PMID: 10366396 DOI: 10.1177/120347549900300409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- H C Nousari
- Department of Dermatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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