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Wasserman I, Chari DA, Gray ST, Naunheim MR, Miloslavsky EM. Ear, Nose, and Throat Manifestations of Vasculitis and Other Systemic Autoimmune Diseases: Otologic, Sinus, and Airway. Rheum Dis Clin North Am 2023; 49:633-645. [PMID: 37331737 DOI: 10.1016/j.rdc.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Auricular, nasal, and laryngeal manifestations occur frequently in rheumatic diseases. Inflammatory ear, nose, and throat (ENT) processes often result in organ damage and have profound effects on quality of life. Herein, we review the otologic, nasal, and laryngeal involvement of rheumatic diseases, focusing on their clinical presentation and diagnosis. ENT manifestations generally respond to treatment of the systemic disease, which is outside the scope of this review; however, adjunctive topical and surgical treatment approaches, as well as treatment of idiopathic inflammatory ENT manifestations will be reviewed.
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Affiliation(s)
- Isaac Wasserman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Divya A Chari
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, University of Massachusetts Memorial Health Center, Worcester, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Matthew R Naunheim
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Eli M Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Staníková L, Formánek M, Hurník P, Kántor P, Komínek P, Zeleník K. Diagnosis of Laryngeal Pemphigus Vulgaris Can Be Facilitated Using Advanced Endoscopic Methods. ACTA ACUST UNITED AC 2021; 57:medicina57070686. [PMID: 34356968 PMCID: PMC8305305 DOI: 10.3390/medicina57070686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022]
Abstract
Background: Isolated laryngeal pemphigus vulgaris (LPV) is rare; however, early diagnosis is crucial in determining its course and prognosis. This paper aims to describe mucosal vascular changes typical for LPV using advanced endoscopic methods, which include Narrow Band Imaging (NBI), IMAGE1-S video-endoscopy and enhanced contact endoscopy (ECE). Materials and Methods: Retrospective analysis of all laryngeal mucosal lesion examined using advanced endoscopic methods during 2018-2020 at tertiary hospital was performed. Results: Videolaryngoscopy examination records of 278 patients with laryngeal mucosal lesions were analyzed; three of them were diagnosed with LPV. Epithelial vascularization of LPV included specific pattern. Intraepithelial papillary capillary loops were symmetrically stratified and were organized into "contour-like lines". This specific vascularization associated with LPV were different from other laryngeal mucosal pathologies. Conclusions: Using advanced endoscopic methods supports early diagnosis of LPV and accelerate the diagnosis and treatment.
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Affiliation(s)
- Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Pavel Hurník
- Department of Pathology, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic;
| | - Peter Kántor
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
- Correspondence:
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Hussain MH, Tanweer F, Sakagiannis G, Mair M, Mahmood S, Ashokkumar S. Pemphigus Vulgaris and Bullous Pemphigoid of the Upper Aerodigestive Tract: A Review Article and Novel Approaches to Management. ORL J Otorhinolaryngol Relat Spec 2021; 83:395-403. [PMID: 33902048 DOI: 10.1159/000515229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autoimmune bullous diseases are rare conditions characterized by blistering of the skin and mucous membranes. The 2 commonest forms are pemphigus vulgaris and bullous pemphigoid. The oral cavity or oropharynx may be the initial site of presentation or often the only site involved. SUMMARY These conditions are often misdiagnosed or overlooked leading to poorer patient outcomes. Due to the chronic nature of these conditions and the systemic effects of treatment, there is a significant associated morbidity and mortality. As such, an understanding of the fundamentals of autoimmune bullous diseases is vital to those working in otolaryngology. The mainstay of management in both conditions is topical and systemic corticosteroids. There is also a role for immunomodulating and non-steroidal anti-inflammatory drugs as adjunct or alternative therapies. Surgical intervention may be required to protect the airway. Often multimodality treatment is required involving multidisciplinary input from otolaryngologists, oral surgeons, dermatologists, and rheumatologists. This review article will highlight the aetiology, pathology, clinical features, investigations, and management of both pemphigus vulgaris and bullous pemphigoid including recent advances in management.
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Affiliation(s)
- Mohammed Hassan Hussain
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Faiz Tanweer
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Georgios Sakagiannis
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Manish Mair
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sara Mahmood
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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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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Mularczyk C, Moynihan M, Yu J. Mucocutaneous Lesions in an Adult Man Who Recently Moved From Mexico. JAMA Otolaryngol Head Neck Surg 2019; 145:965-966. [PMID: 31436804 DOI: 10.1001/jamaoto.2019.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher Mularczyk
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Illinois at Chicago
| | - Matthew Moynihan
- Department of Anesthesia, College of Medicine, University of Illinois at Chicago
| | - Jeffrey Yu
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Illinois at Chicago
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Mini PN, Sadeep MS. Pemphigus – A clinical study with clinico-immuno-histopathologic correlation. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmgims.jmgims_18_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maderal AD, Lee Salisbury P, Jorizzo JL. Desquamative gingivitis. J Am Acad Dermatol 2018; 78:839-848. [DOI: 10.1016/j.jaad.2017.05.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022]
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Ohki M, Kikuchi S. Nasal, oral, and pharyngolaryngeal manifestations of pemphigus vulgaris: Endoscopic ororhinolaryngologic examination. EAR, NOSE & THROAT JOURNAL 2017; 96:120-127. [PMID: 28346642 DOI: 10.1177/014556131709600311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pemphigus vulgaris is an autoimmune blistering disorder that involves the skin and mucous membranes. Few reports have described nasal and oropharyngolaryngeal lesions in pemphigus vulgaris using an endoscopic ororhinolaryngologic examination. We retrospectively reviewed the clinical records of 11 patients with pemphigus vulgaris between 2001 and 2013 with respect to their symptoms, lesion sites, lesion features, and treatments received. All patients had undergone an endoscopic ororhinolaryngologic examination. Their mucosa-related symptoms were sore throat, oral pain, odynophagia, gingival bleeding, hoarseness, and epistaxis. The most frequent sites were the oral cavity (gingiva and buccal mucosa), larynx (epiglottis and vocal fold), oropharynx (soft palate), and nasal cavity (nasal septum). Lesions were typically characterized by erosion, erosion with a whitish exudate, and erythematous patches. Thus, our study findings reveal that pemphigus vulgaris involves both the nasal and oropharyngolaryngeal regions. Patients with pemphigus vulgaris should undergo an endoscopic ororhinolaryngologic examination to determine the range of their lesions.
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Affiliation(s)
- Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 350-8550, Japan.
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España A, Fernandez S. Exploring beyond the oral mucosa in patients affected with autoimmune blistering diseases: the importance of endoscopic procedures. J Eur Acad Dermatol Venereol 2016; 31:791-797. [PMID: 27624852 DOI: 10.1111/jdv.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
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Affiliation(s)
- A España
- Department of Dermatology, School of Medicine, University Clinic of Navarra, Navarra, Spain.,Unit of Autoimmune Blistering Skin Disorders, School of Medicine, University Clinic of Navarra, Navarra, Spain
| | - S Fernandez
- Department of Otorhinolaryngology, School of Medicine, University Clinic of Navarra, Navarra, Spain.,Unit of Autoimmune Blistering Skin Disorders, School of Medicine, University Clinic of Navarra, Navarra, Spain
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Meric A, Dogan R, Veyseller B, Su O, Ozucer B, Tugrul S, Ozturan O. Evaluation of olfaction in patients with pemphigus vulgaris. Am J Rhinol Allergy 2015; 28:e90-4. [PMID: 24717939 DOI: 10.2500/ajra.2014.28.4023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is an autoimmune disease characterized by acantholysis. PV decreases quality of life and leads to morbidity and mortality. Although the association between PV and otolaryngeal disease has been studied, its effect on olfaction has not been investigated objectively and quantitatively. METHODS Twenty-eight patients with PV and 28 healthy volunteers were included in the study. Lesions were identified via nasal endoscopic examination. Nasal symptoms (itching, obstruction, pain, bleeding, and crusting) were recorded. Volunteers were asked to evaluate their olfactory function via a visual analog scale. The Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test was performed (butanol threshold test and identification test), and the score was calculated as the mean ± SD. RESULTS The mean age of the PV group (group 1: 10 male 18 female subjects) was 48.7 ± 8.9 years. The mean age of the control group (group 2: 17 male and 11 female subjects) was 48.0 ± 1.1 years. All nasal symptoms, except itching, were more severe in the PV group (p < 0.05). Nasal lesions were more common in the PV group (p = 0.0001). Evaluation of olfactory function revealed significantly lower scores in the PV group for both the butanol threshold test and the identification testing as well as the CCCRC total score (p = 0.001). PV patients with nasal lesions had significantly more nasal symptoms (p < 0.05). A negative correlation was found between the number of lesions and the olfactory scores in group 1 for the butanol threshold test, identification testing, and the CCCRC total scores, respectively (p = 0.002, p = 0.010, and p = 0.001, respectively). CONCLUSION PV causes olfactory dysfunction leading to eventual hyposmia that decreases quality of life. We suggest that olfactory testing be included in PV evaluation for the diagnosis and treatment of hyposmia, when necessary.
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Affiliation(s)
- Aysenur Meric
- Department of Otolaryngology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
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11
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An unusual epiglottis synechiae managed with transoral robotic surgery in a patient with pemphigus vulgaris. J Craniofac Surg 2014; 24:1864-5. [PMID: 24036806 DOI: 10.1097/scs.0b013e3182a21097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vinall C, Stevens L, McArdle P. Pemphigus vulgaris: a multidisciplinary approach to management. BMJ Case Rep 2013; 2013:bcr-2013-200479. [PMID: 24343801 DOI: 10.1136/bcr-2013-200479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pemphigus vulgaris (PV) is a rare but potentially life-threatening autoimmune disease affecting the mucosa and the skin. The disease is caused by circulating antibodies to desmosomes (important adhesion proteins linking cells together). Disruption of these intercellular connections results in a loss of cohesion between cells (acantholysis). The clinical result of this process is the development of multiple blisters that easily rupture, leaving behind painful sloughing eroded areas of mucosa and/or skin. We report a case of severe PV in a 56-year-old man presenting with widespread, painful, eroded mucocutaneous lesions. The severity of the disease demanded a range of medical and surgical specialties to successfully manage the problem. This paper highlights the importance of an early multidisciplinary team approach to improve the outcome of patients suffering with this disease.
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Affiliation(s)
- Christopher Vinall
- Department of Oral & Maxillofacial Surgery, Derriford Hospital, Plymouth, UK
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13
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Anal involvement in pemphigus vularis. Autoimmune Dis 2013; 2013:609181. [PMID: 24298388 PMCID: PMC3835701 DOI: 10.1155/2013/609181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 09/19/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucosa. Anal mucosa may be involved in PV, but the frequency and clinical profile are not fully ascertained. Objective. The aim was to investigate the involvement of the anal area in newly diagnosed PV patients. Patients and Methods. A total of 168 consecutive newly diagnosed PV patients were enrolled. Anal symptoms and signs, involvement of other body sites, and severity of disease were recorded. Results. A total of 47 out of 168 patients (27.9%) had involvement of the anal area. Anal involvement was significantly associated with PV lesions in ophthalmic (P = 0.03), nasal (P = 0.02), and genital mucosa (P < 0.001) but not the oral cavity (P = 0.24). There was a significant association between number of involved mucosal sites and anal involvement (P < 0.001). Anal involvement was associated with oral severity (P = 0.02). Constipation was the most frequent symptom (73.8%) followed by pain on defecation (50%). Seventeen patients (36%) were symptom-free. Erosion was the most frequent sign (91.5%). Conclusion. Anal involvement in PV seems to be more frequent than previously assumed. Routine anal examination is recommended even in asymptomatic patients as anal involvement appears to correlate with the severity of PV.
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Fawzy MM, Hegazy RA, Abdel Fattah AF. Ear, nose, and throat involvement in Egyptian patients with pemphigus vulgaris: a step towards a better management. Int J Dermatol 2013; 52:1268-73. [PMID: 23829869 DOI: 10.1111/j.1365-4632.2012.05846.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The frequency of ear, nose, and throat (ENT) involvement in pemphigus vulgaris (PV) is not clear; thereby, the importance of setting routine ENT examination for patients with PV could not be deduced. OBJECTIVE Determine the prevalence of ENT involvement in patients with PV in Egypt; to modify the routine protocol and achieve a step towards better management. PATIENTS AND METHODS Thirty-four patients with PV were included. Patients were asked about ENT symptomatology and evaluated for ENT manifestations. RESULTS Twenty-five patients complained from ENT symptoms (74%). The pharyngeal/laryngeal-related symptoms were the most common. Eighty-two percent of patients had positive endoscopic findings. The most common were pharyngeal/laryngeal (76.5%). In total, the positive endoscopic findings superseded the positive symptomatic findings. More severe involvement was documented in non-smoking patients (P < 0.05). CONCLUSION Full ENT examination as a routine for all patients with PV could be of great value, as it would lead to more accurate diagnosis, therefore improved management.
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Affiliation(s)
- Marwa Mohamed Fawzy
- Departments of Dermatology and Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Pemphigus vulgaris and infections: a retrospective study on 155 patients. Autoimmune Dis 2013; 2013:834295. [PMID: 23844280 PMCID: PMC3697281 DOI: 10.1155/2013/834295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/19/2013] [Accepted: 06/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background. Autoimmune process and immunosuppressive therapy of pemphigus vulgaris would predispose the patients to infections. Aim. We aimed to study the prevalence of infection and pathogenic agents in pemphigus vulgaris patients admitted to dermatology service. Material and methods. This retrospective study was conducted on 155 pemphigus vulgaris patients (68 males, 87 females) admitted to dermatology service between 2009 and 2011. In this study, the diagnosis of pemphigus vulgaris was confirmed by light microscopic and direct immunofluorescence findings. Data were collected through a questionnaire.
Results. Of 155 pemphigus vulgaris patients, 33 had infection at admission and 9 acquired nosocomial infection. In addition, 37 cases of oral candidiasis and 15 cases of localized herpes simplex were recorded. Totally, 94 cases of infection were recorded. The occurrence of infection was significantly related to the severity of disease, number of hospital admissions, and presence of diabetes mellitus. The most common pathogenic germs isolated from cultures were Staphylococcus aureus and Escherichia coli. Conclusion. Severity of pemphigus vulgaris and diabetes were directly related with tendency to infections. Staphylococcus aureus and Escherichia coli were the most common pathogenic agents. Due to limitations of retrospective study, a prospective study is recommended.
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Fernández S, España A, Navedo M, Barona L. Study of oral, ear, nose and throat involvement in pemphigus vulgaris by endoscopic examination. Br J Dermatol 2013; 167:1011-6. [PMID: 22716123 DOI: 10.1111/j.1365-2133.2012.11098.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is an autoimmune blistering skin disorder characterized by the presence of suprabasal acantholysis and autoantibodies against desmoglein 3. There are two different clinical forms: mucocutaneous (MCPV) and mucosal (MPV). However, little is known about PV lesions in oral, ear, nose and throat (OENT) areas produced by the very dynamic of the anatomical structures involved in the functions of the aerodigestive tract. OBJECTIVES To investigate the pattern of OENT manifestations in PV, and their relationship with physiological traumatic mechanisms in stratified squamous epithelial structures. METHODS A prospective analysis of 40 patients diagnosed with MCPV (22 patients) or MPV (18 patients) was carried out at the University Clinic of Navarra. OENT manifestations were evaluated in all patients endoscopically. OENT involvement was divided into anatomical areas. RESULTS The most frequent symptom was pain, mainly on oral mucosa (87·5%). Buccal mucosa (90%), posterior wall of pharynx (67·5%), upper edge of epiglottis (85%) and nasal vestibule (70%) were the areas most frequently affected in the OENT mucosa. These localizations were related to physiological traumatic mechanisms in polystratified squamous epithelial structures. CONCLUSIONS OENT endoscopy should be included in the examination of all patients with PV. Knowledge of the most frequent localizations of active lesions on OENT mucosa in PV will help us to interpret more efficiently the findings from OENT endoscopy. Also, information related to traumatic physiological mechanisms on OENT areas must be offered to patients in order to avoid the appearance of new active PV lesions.
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Affiliation(s)
- S Fernández
- Department of Otorhinolaryngology, Unit of Autoimmune Blistering Skin Diseases, University Clinic of Navarra, School of Medicine, PO Box 4209, Pamplona 31080, Navarra, Spain
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Koga H, Tsuruta D, Ohyama B, Ishii N, Hamada T, Ohata C, Furumura M, Hashimoto T. Desmoglein 3, its pathogenecity and a possibility for therapeutic target in pemphigus vulgaris. Expert Opin Ther Targets 2013; 17:293-306. [DOI: 10.1517/14728222.2013.744823] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Laryngeal involvement in pemphigus vulgaris: a proposed classification. The Journal of Laryngology & Otology 2012; 126:1041-4. [DOI: 10.1017/s0022215112001375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:(1) To investigate the incidence of laryngeal involvement in a large series of patients with pemphigus vulgaris, using endoscopic examination, (2) to describe the lesions, and (3) to establish a classification of laryngeal involvement in pemphigus vulgaris based on the location of the lesions.Study design:Prospective study.Methods:A total of 40 sequentially treated pemphigus vulgaris patients, diagnosed using clinical, histological and immunofluorescence criteria, were evaluated for laryngeal manifestations using endoscopic examination. The results were used to establish a graded classification of laryngeal involvement according to the location of the lesions.Results:Active laryngeal lesions (ulcers or blisters) were found in 16 patients (40 per cent). Of these, 37.5 per cent were classified as grade I, 20 per cent as grade II, 20 per cent as grade III and 17.5 per cent as grade IV.Conclusion:Laryngeal involvement is common in pemphigus vulgaris and must be considered at the point of diagnosis. Grade I lesions are the most frequent.
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Abstract
Pemphigus vegetans is an unusual form of pemphigus vulgaris. Pemphigus of the head and neck region is usually found in areas with mucosa, such as the mouth and pharynx. We present a fascinating case of pemphigus vegetans arising from the nasal dorsum that completely deformed the external nose of a 43-year-old woman. The patient was treated successfully with high-dose prednisone.
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Affiliation(s)
- Geoffrey A Sigmund
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Venugopal SS, Murrell DF. Diagnosis and Clinical Features of Pemphigus Vulgaris. Immunol Allergy Clin North Am 2012; 32:233-43, v-vi. [DOI: 10.1016/j.iac.2012.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Robati RM, Rahmati-Roodsari M, Dabir-Moghaddam P, Farnaghi A, Mahboobi-rad F, Rahimi H, Toossi P. Mucosal manifestations of pemphigus vulgaris in ear, nose, and throat; before and after treatment. J Am Acad Dermatol 2011; 67:e249-52. [PMID: 22015151 DOI: 10.1016/j.jaad.2011.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/14/2011] [Accepted: 06/16/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disease, mediated by autoantibodies directed against antigens on the keratinocyte cell surface of stratified squamous epithelia. The frequency of ear, nose, and throat (ENT) involvement in PV is not clearly identified. OBJECTIVE We sought to evaluate the ENT involvement in new patients with PV examined by ENT endoscopy before and after treatment. METHODS This study included 41 new patients with PV. All patients were evaluated for ENT manifestations by otoscopic and endoscopic examination before treatment. After these examinations, the patients received proper treatment according to standard protocols. Thirty patients were re-evaluated by endoscopic examination after clinical remission of mucocutaneous signs. RESULTS A total of 41 (33 [80.5%] male and 8 [19.5%] female) patients with mean age of 44.56 ± 12.76 years entered this study. In ENT examination of patients before the treatment, 11 (26.8%) patients showed ear, 15 (36.6%) nasal, 37 (90.3%) oral, 25 (61%) pharyngeal, and 24 (58.5%) laryngeal involvement. Thirty patients underwent the posttreatment ENT examination. We found ear signs in 2 (6.7%), nasal involvement in 1 (3.3%), oral signs in 4 (13.3%), pharyngeal manifestations in 6 (20%), and laryngeal signs in 3 (10%) patients after treatment. The treatment was significantly effective in the improvement of mucosal lesion in different sites (P < .01). LIMITATION Eleven patients refused to undergo posttreatment ENT examination. CONCLUSION ENT evaluation may be worthwhile to evaluate the disease extension in patients with PV more definitely and exclude other potential etiologies in recalcitrant patients.
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Affiliation(s)
- Reza Mahmoud Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran.
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Abstract
Autoimmune bullous diseases are associated with autoimmunity against structural components that maintain cell-cell and cell-matrix adhesion in the skin and mucous membranes. They include those where the skin blisters at the basement membrane zone and those where the skin blisters within the epidermis (pemphigus vulgaris, pemphigus foliaceus, and other subtypes of pemphigus). The variants of pemphigus are determined according to the level of intraepidermal split formation. There are 5 main variants of pemphigus: pemphigus vulgaris, pemphigus foliaceus, pemphigus erythematosus, drug-induced pemphigus, and paraneoplastic pemphigus. This review focuses only on pemphigus vulgaris.
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Joly P, Sin C. Pemphigus : revue de la littérature. Ann Dermatol Venereol 2011; 138:182-200. [DOI: 10.1016/j.annder.2011.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 01/07/2011] [Indexed: 11/16/2022]
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Kavala M, Altıntaş S, Kocatürk E, Zindancı I, Can B, Ruhi C, Turkoglu Z. Ear, nose and throat involvement in patients with pemphigus vulgaris: correlation with severity, phenotype and disease activity. J Eur Acad Dermatol Venereol 2011; 25:1324-7. [PMID: 21348898 DOI: 10.1111/j.1468-3083.2011.03981.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is the most common clinical form of pemphigus that is characterized by easily ruptured or loose bulla formation on skin and/or mucosa. The frequency of the ear, nose and throat involvement of PV is not clearly defined. OBJECTIVES To evaluate the frequency of ear, nose and throat (ENT) involvement in patients suffering from PV who had been recently diagnosed or exacerbated under follow up and to determine the association with ENT symptoms, clinical involvement, severity and duration of pemphigus vulgaris. MATERIALS AND METHODS The study group included a total of 38 PV patients comprising 24 new patients and 14 patients who showed exacerbations while on complete remission or under treatment. All patients were asked about ENT symptoms and endoscopic examination were performed to evaluate the presence of nasal, pharynx, larynx and ear involvement. RESULTS Of the 38 patients, 33 (87%) had active PV lesions on endoscopic evaluation. Twenty-five patients (66%) had lesions on pharynx, twenty-one (55%) on larynx, twenty-nine (76%) on nasal mucosa and four (10%) on the ear mucosa. ENT involvement was not associated with the severity and the clinical involvement of the disease. Pharyngeal and nasal involvement was significantly associated with symptoms, while laryngeal and ear involvement was not found to be significantly associated with symptoms. Nasal and ear involvement was not associated with the duration of the disease while pharyngeal and laryngeal involvement favored newly diagnosed patients. CONCLUSIONS Our results revealed that high number of patients with PV may present with active ENT lesions, furthermore patients with ear, nose and throat involvement may be asymptomatic and active lesions may be found in patients without any ENT symptoms. Therefore it should be considered that to understand the real extent of PV involvement, endoscopic ENT evaluation should be performed in patients with or without symptoms.
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Affiliation(s)
- M Kavala
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul, Turkey
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Miziara ID, Costa KC, Mahmoud A, Weber R, Wilhelmsen NSW, Imamura R. Laryngeal manifestations in atypical recurrent aphthous stomatitis. Braz J Otorhinolaryngol 2009; 75:660-4. [PMID: 19893932 PMCID: PMC9442197 DOI: 10.1016/s1808-8694(15)30514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 10/12/2008] [Indexed: 11/28/2022] Open
Abstract
Recurrent aphthoid stomatitis is characteristically observed in children and adolescents in the form of painful relapsing ulcers in the oral mucosa unaccompanied by evidences of systemic disease. The ulcers appear every one or two weeks for at least one entire year. Some patients suspected for recurrent aphthoid stomatitis develop lesions in atypical sites - mainly in the larynx - concurrently to the ones found in the oral mucosa. Aim this study aims to describe a series of recurrent aphthoid stomatitis patients with atypical laryngeal injuries. Study design: this is a case series study. Materials and method patients diagnosed with recurrent aphthoid stomatitis with oral mucosa ulcers and laryngeal symptoms without altered lab test results and no evidence of systemic disease underwent fibroscopic examination, oral and laryngeal biopsies, followed by specimen evaluation by direct immunofluorescence. Results all six patients in this series had acute and chronic inflammatory processes according to pathology studies and negative direct immunofluorescence test results. Conclusion laryngeal involvement in recurrent aphthoid stomatitis is rare. Therefore, during diagnostic examination thorough clinical history and meticulous physical examination accompanied by fibroscopic examination are necessary. When atypical lesions are found, biopsies for histological evaluation and direct immunofluorescence tests are required.
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Affiliation(s)
- Ivan Dieb Miziara
- São Paulo University Medical School. Stomatology Service, ENT Division, São Paulo University Hospital
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Cunha PR, Barraviera SRCS. Dermatoses bolhosas auto-imunes. An Bras Dermatol 2009; 84:111-24. [PMID: 19503978 DOI: 10.1590/s0365-05962009000200003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 12/19/2008] [Indexed: 12/20/2022] Open
Abstract
Dermatoses bolhosas autoimunes são doenças cuja manifestação cutânea primária e fundamental consiste em vesículas e bolhas. Classificam-se conforme a localização da bolha, em intraepidérmica e subepidérmica. Os pacientes produzem autoanticorpos contra estruturas específicas da pele detectáveis por técnicas de imunofluorescência, immunobloting e Elisa. Os recentes avanços da biologia molecular e celular têm permitido conhecer esses autoantígenos, contra os quais os pacientes se sensibilizam e que estão localizados na epiderme ou na junção dermoepidérmica. São doenças de baixa incidência, porém de elevada morbidade e por vezes letais. O objetivo deste trabalho é revisar e descrever os progressos nos conhecimentos de quatro doenças vésico-bolhosas autoimunes: pênfigo foliáceo endêmico (fogo selvagem), pênfigo vulgar, penfigóide bolhoso e dermatite herpetiforme.
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Affiliation(s)
- Paulo R. Cunha
- Faculdade de Medicina de Jundiaí; Universidade de São Paulo, Brasil; New York University, Estados Unidos da América
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Akman A, Kacaroglu H, Yilmaz E, Alpsoy E. Periodontal status in patients with pemphigus vulgaris*. Oral Dis 2008; 14:640-3. [DOI: 10.1111/j.1601-0825.2008.01445.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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España A, Fernández S, del Olmo J, Marquina M, Pretel M, Ruba D, Sánchez-Ibarrola A. Ear, nose and throat manifestations in pemphigus vulgaris. Br J Dermatol 2007; 156:733-7. [PMID: 17493073 DOI: 10.1111/j.1365-2133.2007.07783.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are two clinical forms: mucosal (MPV) and mucocutaneous (MCPV). The frequency of ear, nose and throat (ENT) involvement in PV is not clearly defined. Only a few isolated individual cases have been reported. OBJECTIVES The objective of our study was to determine the incidence of ENT involvement in patients with PV. PATIENTS We studied prospectively all 16 patients diagnosed with PV and treated in the Department of Dermatology of the University Clinic of Navarra between 2001 and 2005. They were 10 cases of MPV and six cases of MCPV. All patients were evaluated for ENT manifestations by endoscopic examination. RESULTS Of the 16 patients, 13 presented with throat symptoms (81%), 12 pharyngeal (75%) and seven laryngeal symptoms (44%). Fourteen patients (88%) had active PV lesions on endoscopic evaluation (eight patients had active lesions on both pharyngeal and laryngeal mucosa, four had PV lesions only on laryngeal mucosa and two had PV lesions on pharyngeal mucosa). Laryngeal lesions were most commonly present in MPV patients. The frequency of nasal symptoms (38%) was lower than active PV lesions (62%) found on ENT examination. Oral symptoms and oral active PV lesions were the most frequent findings (94%). Only three patients with MCPV showed erosions on the external auditory canal. CONCLUSIONS As ENT endoscopy allows more extensive areas of mucosa to be examined than simple visual inspection, we recommend that it be included in the examination of all patients with PV. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved.
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Affiliation(s)
- A España
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, 31080 Pamplona, Navarra, Spain.
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Dańczak-Pazdrowska A, Pazdrowski J, Bowszyc-Dmochowska M, Dmochowski M. Zmiany w krtani w pęcherzycy zwykłej z dominacją zmian na błonach śluzowych. Otolaryngol Pol 2007; 61:509-12. [DOI: 10.1016/s0030-6657(07)70472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Vasiliou A, Nikolopoulos TP, Manolopoulos L, Yiotakis J. Laryngeal pemphigus without skin manifestations and review of the literature. Eur Arch Otorhinolaryngol 2006; 264:509-12. [PMID: 17111102 DOI: 10.1007/s00405-006-0208-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 10/15/2006] [Indexed: 11/24/2022]
Abstract
Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.
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Affiliation(s)
- A Vasiliou
- Department of Otorhinolaryngology, Athens University, Ippokration Hospital, Athens, Greece
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Uzun S, Durdu M, Akman A, Gunasti S, Uslular C, Memisoglu HR, Alpsoy E. Pemphigus in the Mediterranean region of Turkey: A study of 148 cases. Int J Dermatol 2006; 45:523-8. [PMID: 16700784 DOI: 10.1111/j.1365-4632.2004.02533.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to describe the epidemiological and clinical features, course, response to treatment, and prognosis of pemphigus in the Mediterranean region of Turkey. METHODS All patients with confirmed pemphigus were prospectively enrolled in two major dermatology departments in the cities of Adana and Antalya in the Mediterranean region between March 1998 and March 2004. Details including demography, findings of clinical examinations, treatment, course, and prognosis were recorded. RESULTS One hundred and forty-eight patients with pemphigus were diagnosed during the 6-year period, with a prevalence of 1.46 and an annual incidence of 0.24 per 100,000 in this region. There was a female predominance with a male to female ratio of 1:1.4. Pemphigus vulgaris (PV) was the most common clinical subtype, identified in 123 patients (83%). The mean age of onset was 43. In 101 (82%) patients with PV, disease began as persistent oral ulcers. The majority of the patients with PV could be managed with middle or high-dose steroids (60-140 mg/day). Complete clinical remission was obtained in 41 (39.4%) patients. The mortality rate was 4.8%. CONCLUSIONS A moderately high incidence of pemphigus was found in the Mediterranean region of Turkey as compared with that encountered in other countries. The commonest clinical subtype was PV with a 9.5-fold higher incidence than pemphigus foliaceus. It is more frequent in middle-aged people and has a female predominance. Although a relatively higher dose of steroid was needed to control the PV, the disease completely remitted in a significant proportion of the patients.
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Affiliation(s)
- Soner Uzun
- Department of Dermatology, Cukurova University School of Medicine, Adana, Turkey.
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Abstract
INTRODUCTION Anal involvement in patients with pemphigus vulgaris has rarely been reported. We report 16 pemphigus vulgaris patients with anal involvement. METHODS We retrospectively reviewed the clinical data on 16 patients treated at a tertiary dermatology referral center. RESULTS Of 16 patients with anal involvement of pemphigus vulgaris, ten were female and six were male. The mean age of onset was 56 (range, 37-82) years. All patients had involvement of pemphigus vulgaris at multiple sites, including oral involvement. Recurrent episodes of anal pemphigus vulgaris were noted in nine (56 percent) patients, with a mean of 2.4 recurrences (range, 1-11). In all patients, pemphigus vulgaris was controlled with systemic and local therapy. Long-term follow-up for a mean of 53 (range, 4-188) months indicated that no long-term sequela occurred because of anal involvement. CONCLUSIONS Anal involvement in pemphigus vulgaris is not very common and generally occurs in patients with severe disease. With appropriate topical and systemic therapy, patients have full recovery with no sequelae.
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Affiliation(s)
- Mohsin Malik
- Department of Medicine, New England Baptist Hospital, Boston, Massachusetts 02120, USA
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Abstract
BACKGROUND Involvement of the genital tract in women with pemphigus vulgaris has rarely been reported. We report 34 patients with pemphigus vulgaris who have involvement of the vulva, vagina, or both. METHODS We reviewed the clinical data on 34 women treated at a tertiary dermatology referral center from July 1988 to June 2005. RESULTS Of 34 patients, 21 had labial involvement, 3 had vaginal involvement, and 10 had both labial and vaginal involvement. The mean age of onset of pemphigus vulgaris was 49 years. All patients had pemphigus vulgaris involvement at multiple other sites, and all had other mucous membrane involvement, most commonly oral (97%). Recurrent episodes of genital pemphigus vulgaris were noted in 35%, with a mean of 6 recurrences (range 1-11). In all the patients the pemphigus vulgaris was controlled with systemic and local therapy. Long-term follow-up for a mean of 76 months (range 9-204) indicated that no long-term sequela occurred due to genital involvement. CONCLUSION Involvement of the female genital tract in pemphigus vulgaris is rare. Vulvar lesions occur more commonly than vaginal lesions. With appropriate topical and systemic therapy, patients can have full recovery with no sequelae. LEVEL OF EVIDENCE II-3.
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Affiliation(s)
- Mohsin Malik
- Department of Medicine, New England Baptist Hospital, 70 Parker Hill Avenue, Boston, MA 02120, USA
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Abstract
Pemphigus is a rare autoimmune disease that results in blistering of the skin and oral cavity. It is caused by autoantibodies directed against cell-surface antigens on keratinocytes, which when targeted lose their cellular adhesion properties and separate from one another to form blisters within the epidermis. Differences in the particular antigens targeted by the antibodies and in the distribution of these antigens in the different regions of the body and in the separate layers of the epidermis result in different clinical manifestations of the disease. The disease is diagnosed based on its clinical manifestations (flaccid blisters and erosions on skin and oral mucosa), histology (epidermal acantholysis), and immunological abnormalities (circulating and tissue-fixed antibodies against keratinocyte surface antigens). Pemphigus, which if left untreated is almost always fatal, is generally managed with topical, oral, or intralesional corticosteroids. Other options include plasmapheresis and intravenous immunoglobulin (IVIg), coupled with cytotoxic drugs. Immunosupressants, anti-inflammatory drugs, and antibiotics are used as adjuvants, but apart from IVIg, these therapy options are non-specific and more research is needed to develop treatments with improved side-effect profiles.
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Affiliation(s)
- Jean-Claude Bystryn
- The Ronald O Perelman Department of Dermatology, New York University School of Medicine, 560 1st Avenue, New York, NY 10016, USA.
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Chams-Davatchi C, Valikhani M, Daneshpazhooh M, Esmaili N, Balighi K, Hallaji Z, Barzegari M, Akhiani M, Ghodsi Z, Mortazavi H, Naraghi Z. Pemphigus: Analysis of 1209 cases. Int J Dermatol 2005; 44:470-6. [PMID: 15941433 DOI: 10.1111/j.1365-4632.2004.02501.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pemphigus is a rare and chronic life-threatening disease. The clinical picture varies in reports from different regions of the world. OBJECTIVE To define the clinical forms of pemphigus in a large cohort of patients. METHODS Prospective analysis of 1209 patients diagnosed and followed at the Pemphigus Research Unit, Tehran University for Medical Sciences, from 1984 to 2003. RESULTS The mean age at onset was 42 years with a female to male ratio of 1.5/1. The most frequent form was pemphigus vulgaris. In pemphigus vulgaris, patients' mucous membrane involvement alone was observed in 18%, skin involvement alone in 12%, and both in 70%. Pemphigus foliaceus was observed in 7% of the patients. Most complications were iatrogenic. CONCLUSION In Iran, pemphigus vulgaris is the most frequent form of pemphigus. Females are more prone to the disease. The incidence of pemphigus in Tehran is approximately 1.6 per 100,000/year, and in Iran 1.0 per 100,000/year. The age of onset was lower than classically reported. Death occurred in 6.2% of the patients. In pemphigus vulgaris, the mucosal and skin form together had a worse prognosis than the other clinical forms.
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Affiliation(s)
- Cheyda Chams-Davatchi
- Tehran University for Medical Sciences, Department of Dermatology, Pemphigus Research Unit, Razi Hospital, Tehran, Iran.
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