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Mahmoudi H, Toosi R, Salehi Farid A, Daneshpazhooh M. Pemphigus Disease and Area Index: Unmet needs in the real-world management of pemphigus. Oral Dis 2024; 30:2275-2277. [PMID: 37602935 DOI: 10.1111/odi.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
Over the past few decades, a number of scoring instruments have been developed to assess the severity and activity of autoimmune bullous diseases (AIBDs) (Daneshpazhooh et al., 2019; Nili et al., 2020; Nili et al., 2021; Nili et al., 2022). The Pemphigus Disease Area Index (PDAI), developed by the International Pemphigus Definitions Group, is an easy-to-use, quick, and reliable method for determining pemphigus severity. As a reliable and effective tool in clinical trials, PDAI may also have some limitations and might require some revisions to be used on a daily basis. Here, we propose some recommendations to improve the use of PDAI in the clinical setting.
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Affiliation(s)
- Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roja Toosi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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2
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Lan Y, Zhang H, Jin H. Pregnancy in pemphigus vulgaris: A systematic review. Am J Reprod Immunol 2024; 91:e13813. [PMID: 38282607 DOI: 10.1111/aji.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
PROBLEM Pemphigus vulgaris may worsen during pregnancy, leading to both maternal and fetal complications. The relationship between pemphigus vulgaris and pregnancy remains unclear, and the outcomes and treatments of pemphigus vulgaris during pregnancy have not been extensively discussed. METHOD OF STUDY This article systematically reviews the literature, focusing on the relationship between pemphigus vulgaris and pregnancy. We conducted comprehensive searches in PubMed, Embase, Cochrane Library, and Web of Science databases, identifying 42 studies reporting the disease course, pregnancy outcomes, and management of both pregnancy and pemphigus vulgaris. RESULTS A total of 57 cases were included in the analysis, categorized into three distinct forms: pemphigus vulgaris onset before pregnancy (n = 33), onset during pregnancy (n = 20), and onset during the postpartum period (n = 4). Fifty four cases reported treatment strategies, among them, 44 cases (81.5%) initially received systemic corticosteroid therapy during pregnancy. Out of these cases, 7 (15.9%) did not achieve successful remission and required alternative treatment approaches. In terms of pregnancy outcomes, 23 out of 62 neonates (37.1%) exhibited skin lesions or tested positive for anti-dsg IgG in their serum, while 16 neonates (25.8%) experienced other complications. CONCLUSIONS These findings highlight the importance of effectively managing pemphigus vulgaris during pregnancy to ensure optimal outcomes.
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Affiliation(s)
- Yining Lan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year MD Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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3
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Aryanian Z, Riyaz IZ, Balighi K, Ahmadzade A, Mahmoudi HR, Azizpour A, Hatami P. Combination therapy for management of pemphigus patients with unexpected therapeutic response to rituximab: A report of five cases. Clin Case Rep 2023; 11:e8208. [PMID: 38028089 PMCID: PMC10675096 DOI: 10.1002/ccr3.8208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The immunosuppressant agents should be considered earlier in the course of treatment with rituximab, possibly after the unfavorable response at first cycle of treatment, especially in male patients and those with high BMI. Abstract Rituximab (RTX) has recently been proposed as an alternative first-line therapy for pemphigus patients. However, there are some rare reports of worsening of pemphigus following RTX therapy in the literature. This study aimed to evaluate the efficacy and safety of using a combination treatment of mycophenolate mofetil or dapsone and methotrexate in case of nonresponse, exacerbation or development of allergic reactions following rituximab therapy in pemphigus patients. In this case series, archive files of pemphigus patient in a tertiary care hospital from 2016 to 2021 who were treated with rituximab were reviewed and those with failure in treatment process including nonresponsiveness, exacerbation or development of allergic reactions to rituximab were identified and assessed. The study includes five patients out of 1245 RTX-treated patients, who did not respond to RTX (one patient) or experienced an exacerbation of disease (two patients) or development of allergic reactions (two patients). Male patients with high BMI (BMI > 25) whose response to rituximab was not good at first cycle and happened to receive rituximab later in the course of disease, had highest number of relapses and benefited the most from this combination immunosuppressive treatment as an alternative for repeating rituximab cycles. The lower risk of relapse and a better chance of remission might indicate the efficacy of adjuvant immunosuppressant therapy in patients with no-response, exacerbation, or allergic reaction to rituximab. These therapeutic effects were better observed in patients who received lower doses of rituximab which could suggest that the immunosuppressant agents should be considered earlier in the course of the disease, possibly after the first failed trial of rituximab therapy.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
- Department of DermatologyBabol University of Medical SciencesBabolIran
- Department of DermatologySchool of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Insha Zainab Riyaz
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
- Department of DermatologySchool of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Ali Ahmadzade
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
| | - Hamid Reza Mahmoudi
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
- Department of DermatologySchool of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Arghavan Azizpour
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
- Department of DermatologySchool of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research CenterRazi HospitalTehran University of Medical SciencesTehranIran
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Chu CY, Lee CH, Lee HE, Cho YT, Hsu CK, Chan TC, Hsieh SC, Wei KC. Taiwanese dermatological association (TDA) consensus for the management of pemphigus. J Formos Med Assoc 2023; 122:540-548. [PMID: 36564301 DOI: 10.1016/j.jfma.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/14/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Pemphigus is an uncommon but life-threatening autoimmune blistering disease characterized by the presence of antibodies against desmogleins. Without effective treatment, pemphigus can result in significant morbidity and mortality. Existing consensus statements on pemphigus management from international medical groups provide varying guidelines, especially on treatment. Thus, on January 4, 2020, a panel of seven dermatology experts from the Taiwanese Dermatological Association (TDA) and one rheumatology expert convened to develop a consensus for the management of pemphigus. These experts with extensive experience in pemphigus management were recommended by their respective teaching hospitals and primary care clinics in Taiwan and by the TDA. The meeting reviewed the available consensus statements from international dermatology groups, including the European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), and the International Bullous Diseases Consensus Group. Using these guidelines as a basis for discussion and consensus formulation, these experts formulated their consensus statement that provides practical, concise but comprehensive recommendations as to the diagnosis, treatment, and monitoring of pemphigus patients in Taiwan. This consensus serves as a clinical reference for physicians for the management of pemphigus in Taiwan or wherever it may be applicable.
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hua-En Lee
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei Branch, Taiwan
| | | | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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5
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Mazaherpour E, Kianfar N, Dasdar S, Sedaghat M, Seyrafi H, Balighi K, Saberi F, Nili A, Farimani Z, Azar PM, Mahmoodi H, Murrell DF, Daneshpazhooh M. Applicability of glucocorticoid toxicity index in pemphigus: Comparison between two groups of rituximab-treated and rituximab-naïve patients. Dermatol Ther 2022; 35:e15902. [PMID: 36200713 DOI: 10.1111/dth.15902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
Rituximab (RTX) combined with short-term glucocorticoids (GC) is an effective therapeutic option for pemphigus. The newly developed Glucocorticoid Toxicity Index (GTI) tool provides the possibility to measure GC toxicities over time. To compare 1-year GTI between two groups of RTX-treated and RTX-naïve patients with pemphigus. The responsiveness of the GTI was also investigated. A prospective cohort of 129 adults with newly diagnosed pemphigus was conducted. GC-related toxicities were assessed at 3-month intervals according to Composite and Specific lists of the GTI. Of the patients, 76.7% (n = 99) received RTX. Throughout the time intervals, RTX-treated patients had lower GTI compared to RTX-naïve ones (p = 0.036). The mean GTI at 1-year was 34.3 in the RTX-treated group and 50.8 in the RTX-naïve group (p = 0.04). The most commonly observed GC-related toxicity was neuropsychiatric manifestations for 34% (224 events). The relapse rate of RTX-treated patients (1%) was significantly lower than RTX-naïve patients (10%) (p = 0.037). The GTI showed no correlation with cumulative GC consumption in both groups (p > 0.05, both). Patients treated with GC alone had remarkably higher GTI than patients treated with GC plus RTX. The GTI is an applicable tool to quantitatively capture GC toxicities at the patient level in pemphigus.
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Affiliation(s)
- Elham Mazaherpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Seyrafi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Saberi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Farimani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoodi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Whales, Sydney, New South Wales, Australia
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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6
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Pregnancy outcomes in women with pemphigus exposed to rituximab before or during pregnancy. Int J Womens Dermatol 2022; 8:e038. [PMID: 35837335 PMCID: PMC9276145 DOI: 10.1097/jw9.0000000000000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023] Open
Abstract
Rituximab (RTX) is an effective treatment for pemphigus; however, the drug labeling recommends not to use RTX within 1 year before conception.
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Shirzad Moghadam F, Kianfar N, Dasdar S, Samii R, Farimani Z, Azar PM, Balighi K, Abedini R, Soori T, Salehi Farid A, Mahmoudi H, Daneshpazhooh M. Adverse outcome and severity of COVID-19 in patients with autoimmune bullous diseases: a historical cohort study. Dermatol Ther 2022; 35:e15672. [PMID: 35768959 PMCID: PMC9349909 DOI: 10.1111/dth.15672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
The ongoing COVID‐19 pandemic has raised concerns regarding the outcome of this infection in patients with autoimmune bullous dermatoses (AIBDs) due to effect of drugs used to treat these disorders. This investigation was performed from the onset of the pandemic to June 1, 2021. Patients with AIBDs who contracted COVID‐19 were evaluated. A generalized linear model was employed to find the predictors of severe COVID‐19 among patients with AIBDs. Ninety‐three patients with AIBDs with a mean age of 50.3 years were evaluated. The most COVID‐19 related symptoms were tiredness (76.3%) myalgia (69%), and cough (63.4%). During follow‐up, the rate of hospitalization and death were 45.2% and 4.3%, respectively. Previous comorbidities (β = 0.61) and mean prednisolone dosage above 10 mg/day in the last 3 months (β = 1.10) significantly increased COVID‐19 severity. Also, vaccination against SARS‐CoV‐2 (β = −1.50) and each passing month from the last rituximab dose decreased severity (β = −0.02). Notably, 19.3% of the patients developed AIBD flare‐ups following COVID‐19 infection. Higher prednisone dose and the shorter interval from the last rituximab infusion were determinants of severe COVID‐19. Physicians should assess the risk versus the benefits when prescribing the medications. Moreover, vaccination could successfully attenuate COVID‐19 severity.
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Affiliation(s)
- Fateme Shirzad Moghadam
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rana Samii
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Farimani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Soori
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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8
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Martora F, Picone V, Fabbrocini G, Megna M. How to decrease systemic corticosteroids in pemphigus patients under rituximab. Health Sci Rep 2022; 5:e639. [PMID: 35677471 PMCID: PMC9169508 DOI: 10.1002/hsr2.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Vincenzo Picone
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
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Nili A, Karimi S, Salehi Farid A, Molhem Azar P, Farimani Z, Shahbazian H, Balighi K, Tavakolpour S, Mahmoudi H, Daneshpazhooh M. Factors associated with the healing time of pemphigus vulgaris oral lesions: a prospective study. Oral Dis 2022. [PMID: 35506253 DOI: 10.1111/odi.14236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study determines the healing time of lesions on different locations and the contributing factors to the healing time in patients with pemphigus. METHODS In this prospective study, newly diagnosed patients with mucosal lesions were included. A dermatologist evaluated the lesions, disease status, side effects and assigned the PDAI. Follow-up visits were conducted monthly until the patient reached complete remission and every three months thereafter. A Tzanck smear was performed on lesions clinically suspected to be herpetic in origin. RESULTS Sixty patients enrolled in the study with a mean age of 45.9 ± 11.7 years. The buccal lesions took the longest to resolve(73[33.5-105.5] days). However, the posterior pharynx lesions showed the shortest healing time(20[13.0-25.5] days). The likelihood of improvement in buccal and soft palate lesions decreased by 5% and 3% with each additional year of age, respectively. Also, the resolution duration of soft palate lesions was significantly shorter in female patients than males(median of 24.0 days vs. 38.5 days). In contrast, lower gingival lesions resolve significantly faster in male patients by a median of 9 days. HSV infection increases the healing time of lesions by 26 days(median of 55 days vs. 29 days, hazard ratio 2.62, 95%CI:1.04-5.92). CONCLUSIONS Buccal and lower gingival lesions are more recalcitrant to treatment, while posterior pharynx lesions heal most rapidly. Furthermore, older age was also associated with a lower rate of lesion improvement.
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Affiliation(s)
- Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shakiba Karimi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Farimani
- Department of Periodontics, School of Dentistry, Alborz University of Medical Science, Karaj, Iran
| | | | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Balighi K, Shams-Davatchi C, Ghobadi S, Daneshpajooh M, Lajevardi V, Mahmoodi H, Aryanian Z, Teymourpour A, Seirafi R, Beigmohammadi F, Tavakolpour S. Retrospective study of gingival involvement in pemphigus: a difficult to treat phenomenon. Dermatol Ther 2022; 35:e15475. [PMID: 35352853 DOI: 10.1111/dth.15475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus is a group of autoimmune diseases characterized by flaccid lesions on the skin and mucous membranes. In pemphigus vulgaris, the most common subtype of pemphigus, lesions might be appeared anywhere on the oral mucosa, mostly in the buccal mucosa. However, the gingiva is a less frequently affected site. METHODS Here, we performed a retrospective study at Tehran University of Medical Sciences, covering a two-year period to identify pemphigus patients with active lesions confined to the gingiva. RESULTS Considering 1787 initially evaluated pemphigus cases, 512 (28.6%) were found to have a history of gingival involvement. Among them, 31 patients had only gingival involvement during their last visit, including 29 (93.5%) women and only two (6.5%) men. The mean of disease duration in this group was 5.29±3.46 years, and they had gingival involvement for a mean of 23.9±19.3 months. Of 28 patients, nine were negative for anti-Dsg3 and 24 were negative for anti-Dsg1. In 24 patients, who received rituximab, the mean PDAI specifically for gingiva was 4.76±0.74 at baseline, which had changed to 4.13±0.75 and 3.26±0.63 three and six months after rituximab administration, respectively. After three months, gingival lesions were either entirely resolved (n=3), partially resolved (n=11), remained unchanged (n=2), or progressed (n=7). CONCLUSIONS Gingiva-confined presentation of lesions in pemphigus could be non-anti-Dsg1/3 dependent in some patients. Such patients do not respond well to conventional treatments and rituximab therapy. More studies on the pathogenesis of gingiva-confined presentation of pemphigus are required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Cheida Shams-Davatchi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Salar Ghobadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpajooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahide Lajevardi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoodi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teymourpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramtin Seirafi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Beigmohammadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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11
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Balighi K, Ashtar Nakhaei N, Daneshpazhooh M, Aryanian Z, Aslani S, Balighi S, Azizpour A. Pemphigus patients with initial negative levels of anti- desmoglein; a subtype with different profile? Dermatol Ther 2022; 35:e15299. [PMID: 34981632 DOI: 10.1111/dth.15299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/04/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus is a blistering autoimmune disease that is characterized by autoantibodies against desmoglins (Dsg), including anti-Dsg1 and anti-Dsg3. Despite the diagnosis of diseases, the anti-Dsg test by Enzyme-linked immunosorbent assay (ELISA) is negative in a small group of pemphigus patients. The aim of this study was to evaluate the clinical course, clinical symptoms, and response to treatment in pemphigus patients with negative levels of anti-Dsg1 and anti-Dsg3. METHODS In this study, the data of pemphigus patients referred to Razi Hospital were retrospectively collected from the medical records from 2016 to 2020. Eight patients, whose initial anti-Dsg1/anti-Dsg3 was negative by the ELISA test, were enrolled and their clinical course, clinical signs, and response to treatment were evaluated. RESULTS The mean age of the subjects (8 females) was 38.75±12.09. The most common phenotype of the subjects was pemphigus vulgaris (PV) with mucosal involvement. Additionally, the common site of blister inception was mouth of the patients. The mean prednisolone dose received by the patients at the initiation was 32.5±13.62 mg/day. According to Pemphigus Disease Area Index (PDAI), 6 patients had mild severity, wile 2 cases had moderate severity. Among the patients, 6 subjects received rituximab (RTX). Also, 5 patients experienced remission after 6.2±5.21 months. CONCLUSION PV is the most common phenotype of the disease and mucosal involvement is more common in patients with negative anti-Dsg-1/3 results. The severity of the lesions in most of the patients is mild at baseline and most patients seems to respond to RTX therapy and reach remission.
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Affiliation(s)
- Kamran Balighi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ashtar Nakhaei
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Aslani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Balighi
- The school of allied medical sciences, Tehran University of Medical Sciences
| | - Arghavan Azizpour
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Seifollahi A, Fazl MR, Setayesh L, Javanbakht MH, Daneshpazhooh M, Shab-Bidar S, Yaseri M. The Association Between Dietary Diversity Score and Cardiovascular Risk Factors Among Patients With Pemphigus Vulgaris: A Cross Sectional Study. Clin Nutr Res 2022; 11:289-301. [DOI: 10.7762/cnr.2022.11.4.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Atefeh Seifollahi
- Department of Cellular, Molecular Nutrition School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Mahboubeh Rezaei Fazl
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Leila Setayesh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Mohammad Hassan Javanbakht
- Department of Cellular, Molecular Nutrition School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Mehdi Yaseri
- Department of Biostatistics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
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13
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Balighi K, Hatami P, Sheikh Aboli MJ, Daneshpazhooh M, Ghiasi M, Mahmoudi HR, Aryanian Z. Multiple cycles of rituximab therapy for pemphigus: A group of patients with difficult- to-treat disease or a consequence of late rituximab initiation? Dermatol Ther 2021; 35:e15249. [PMID: 34910350 DOI: 10.1111/dth.15249] [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: 10/02/2021] [Revised: 11/10/2021] [Accepted: 12/02/2021] [Indexed: 12/24/2022]
Abstract
Pemphigus is a serious autoimmune disease with few appropriate therapeutic options. Although rituximab (RTX) has recently shown great promise in this regard, the best protocol of its administration is remains to be elucidated. This study aimed to evaluate the patients who need at least 3 cycles of treatment with RTX to identify hard-to-treat patients' characteristics, which might lead to consider more prompt protocols for treatment of them. A retrospective cross-sectional study was conducted on 45 patients with pemphigus vulgaris who received at least 3 cycles of RTX. Their demographic, clinical, and laboratory data as well as details of treatment protocol and final clinical situation of patients were evaluated. Totally, 45 patients (21 men and 24 women) with mean age of 44.33 years were included in this paper. Women were about 8 years older than men (mean age: 48.1 years versus 40.1 years, p: 0.011) and needed RTX approximately 2 years later in their course of disease (gap: 41.04 months vs. 14.85 months, p: 0.003). Buccal, truncal, and scalp regions were the most frequent sites of involvement respectively. A significant decrease in both anti-Dsg1, 3 was seen at last visit compared to baseline. However, the amount of this decrement was not significantly different between them (p: 0.083). Partial remission in 31.11%, complete remission in 24.44%, relapse in 15.56%, partial remission on treatment in 15.56% and complete remission on treatment in 13.33% were seen at the last follow-up session. RTX is an effective medication for PV even in patients with refractory disease and its therapeutic effect is increased with each subsequent cycle. Male gender, severe oral mucosal involvement on disease onset and extensive scalp and truncal lesions as first cutaneous manifestation of disease are more likely to be signs of refractory PV. Hence, it is reasonable to consider more prompt protocols for treatment of these cases. Moreover, late prescription of RTX during the course of disease might play a role in presence of more resistant form of disease.
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Affiliation(s)
- Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghiasi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
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14
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Nili A, Salehi Farid A, Asgari M, Tavakolpour S, Mahmoudi H, Daneshpazhooh M. Current status and prospects for the diagnosis of pemphigus vulgaris. Expert Rev Clin Immunol 2021; 17:819-834. [PMID: 34162306 DOI: 10.1080/1744666x.2021.1945925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Pemphigus vulgaris (PV) is an intraepidermal autoimmune bullous disease (AIBD) characterized by autoantibodies against desmosomal adhesion proteins, most commonly desmoglein (Dsg)3, leading to the suprabasal cleft formation and acantholysis.Areas covered: Direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) studies display the intercellular deposition of IgG/C3 throughout the epidermis and presence of circulating autoantibodies respectively, as a net-like pattern. However, the target antigen remains unknown using immunofluorescence techniques. Thanks to the development of Dsg ELISA, using recombinant technology, circulating antibodies against Dsg1 and 3 could be detected sensitively. It is possible to differentiate PV from pemphigus foliaceus (PF) using this assay. BIOCHIP mosaic and multivariant ELISA are two novel serologic methods with the added value of the ability to screen several AIBDs simultaneously.Non-Dsg1/3 antigens are also involved in the pathogenesis of PV and investigated more deeply thanks to the protein microarrays technique. Additionally, patients with high values of anti-Dsg1/3 may be lesion-free, suggesting the presence of nonpathogenic autoantibodies.Expert opinion: Newer diagnostic methods to replace traditional techniques should possess high sensitivity and specificity and be widely available, noninvasive, and relatively cheap. The newly developed methods need to be further evaluated before being recommended for routine use.
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Affiliation(s)
- Ali Nili
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Asgari
- Department of Pathology and Laboratory Medicine, Yosemite Pathology Medical Group, San Ramon Regional Medical Center, San Ramon, CA, USA
| | - Soheil Tavakolpour
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Hamidreza Mahmoudi
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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15
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Daneshpazhooh M, Tavakolpour S, Salehi Farid A, Ebadi M, Nili A, Rashidian M, Mahmoudi H. Pustular eruption after biosimilar rituximab infusion: report of acute generalized exanthematous pustulosis in two patients with pemphigus. Int J Dermatol 2021; 61:e14-e17. [PMID: 34156705 DOI: 10.1111/ijd.15706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Ebadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Bardazzi F, Loi C, Chessa Marco A, Di Altobrando A, Filippi F, Lacava R, Viviani F, Balestri R, Leuzzi M, Sacchelli L. Therapeutic approaches and targets for treatment of autoimmune bullous diseases. Dermatol Ther 2021; 34:e15032. [PMID: 34145701 DOI: 10.1111/dth.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023]
Abstract
Autoimmune bullous diseases are a heterogeneous group of diseases characterized by the development of cutaneous and mucosal vesicles, blisters, and finally erosions. The common pathogenetic mechanism is the presence of autoantibodies targeting structural proteins of the skin and mucous membranes (demosomes and hemidesmosomes): in the case of pemphigus, the antigens are intraepidermal, whereas in the case of pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa acquisita they are subepidermal. Mucosal involvement typically affects the oral and ocular mucosa, but in some cases, the upper airways or the upper digestive tract are affected. The burden on patients' lives could be severe due to the impairment of normal feeding or breathing. In other cases, they may represent paraneoplastic syndromes. Since autoimmune bullous diseases may result in significant morbidity and mortality, depending on the grade of cutaneous and mucosal involvement, a prompt therapeutic approach is mandatory and, in recalcitrant cases, may be challenging. The first line therapy consists of corticosteroids, both topical and systemic. Once remission or control of the acute phase is obtained, adjuvant therapies need to be introduced in order to spare the corticosteroid load and minimize side effects such as iatrogenic diabetes or osteoporosis. Herein, we describe all current therapeutic approaches to autoimmune bullous diseases, also including emerging therapies.
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Affiliation(s)
- Federico Bardazzi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Camilla Loi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Adriano Chessa Marco
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Ambra Di Altobrando
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Federica Filippi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Rossella Lacava
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Filippo Viviani
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Riccardo Balestri
- Division of Dermatology, Rare Disease Outpatient Service, Santa Chiara Hospital, Trento, Italy
| | - Miriam Leuzzi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Lidia Sacchelli
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
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17
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Abstract
The first cases of coronavirus disease 2019 (COVID-19) in Iran were detected on February 19, 2020. Soon the entire country was hit with the virus. Although dermatologists were not immediately the frontline health care workers, all aspects of their practice were drastically affected. Adapting to this unprecedented crisis required urgent appropriate responses. With preventive measures and conserving health care resources being the most essential priorities, dermatologists, as an integral part of the health system, needed to adapt their practices according to the latest guidelines. The spectrum of the challenges encompassed education, teledermatology, lasers, and other dermatologic procedures, as well as management of patients who were immunosuppressed or developed drug reactions and, most importantly, the newly revealed cutaneous signs of COVID-19. These challenges have paved the way for new horizons in dermatology.
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Affiliation(s)
- Maryam Daneshpazhooh
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - HamidReza Mahmoudi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Mahmoudi H, Tavakolpour S, Balighi K, Farid AS, Nili A, Jan D, Daneshpazhooh M. Rituximab in practice: Clinical evaluation of patients with pemphigus after rituximab administration. Dermatol Ther 2020; 34:e14633. [PMID: 33280226 DOI: 10.1111/dth.14633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)-a B-cell depleting agent-for the management of patients with moderate-to-severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, nonresponders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after 3 months, reaching remission until 6 months, and the ability of corticosteroid tapering in 6 months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long-term side effects are discussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time-points, including 1, 2, 3, and 6 months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.
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Affiliation(s)
- Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Delnavaz Jan
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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Abedini R, Mahmoudi H, Kordestani S, Habib FN, Abyaneh M, Rahemi H. Comparison of topical nanocolloidal silver formulation use with eosin 2% solution in management of hard-to-heal ulcers in patients with pemphigus vulgaris. J Wound Care 2020; 29:664-668. [PMID: 33175623 DOI: 10.12968/jowc.2020.29.11.664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the effect of a nanocolloidal silver-based gel called SilvoGel (ChitoTech, Iran) versus eosin (prepared by Razi Hospital, Iran) among patients with immunobullous disease. METHOD This blind, randomised controlled study was carried out on patients with pemphigus vulgaris who had hard-to-heal ulcers, divided into two equal-sized groups: one treatment group receiving the nanocolloidal silver-based gel and the control group receiving the conventional eosin. RESULTS A total of 32 patients participated in the study. In both the treatment and control groups, ulcer area, exudate and tissue type improved significantly (p<0.001 for all measures). A significantly higher rate of improvement in ulcer area was observed in the treatment group compared with the control group (p<0.001). Both patient and physician satisfaction were significantly higher in the treatment group compared with the control group (p=0.003 and p=0.01, respectively). CONCLUSION The results of this study indicate that use of the nanocolloidal silver-based gel for treating patients with immunobullous disease including pemphigus could potentially increase the rate and quality of wound healing.
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Affiliation(s)
- Robabeh Abedini
- 1 Tehran University of Medical Sciences, Dermatology Department, Razi Hospital, Iran
| | - Hamidreza Mahmoudi
- 1 Tehran University of Medical Sciences, Dermatology Department, Razi Hospital, Iran
| | - Soheila Kordestani
- 2 Medical Engineering Department, Amirkabir University of Technology, Tehran, Iran.,3 ChitoTech Inc, Unit 9&11, East Wing, No. 83, Khaghani Building, Somayeh Avenue, Tehran, Iran
| | - Farzaneh Nayeb Habib
- 2 Medical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Mitra Abyaneh
- 3 ChitoTech Inc, Unit 9&11, East Wing, No. 83, Khaghani Building, Somayeh Avenue, Tehran, Iran
| | - Homayoun Rahemi
- 3 ChitoTech Inc, Unit 9&11, East Wing, No. 83, Khaghani Building, Somayeh Avenue, Tehran, Iran
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20
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Mazloom E, Daneshpazhooh M, Shokouhi Shoormasti R, Balighi K, Mahmoudi H, Moradi Ketisari M, Eslami Faresani V, Ghandi N. Intralesional injection of biosimilar rituximab in recalcitrant mucocutaneous lesions of patients with pemphigus vulgaris: A pilot study. Dermatol Ther 2020; 33:e14407. [PMID: 33051954 DOI: 10.1111/dth.14407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Abstract
The efficacy of intravenous rituximab (RTX) in patients with pemphigus have been shown in the previous studies. The study aimed to investigate the effectiveness of intralesional injection of RTX in the healing of pemphigus lesions, with lower doses and probable better safety profile than intravenous RTX. Eleven Pemphigus patients with recalcitrant lesions received two intralesional injections of biosimilar RTX, 5 mg/cm2 . During 6 months follow-up, Pemphigus Disease Area Index, the patients' satisfaction, quality of life, the disease activity, the number and size of lesions, the anti-desmoglein (Dsg) 1 and 3 antibodies and the count of CD4+ and CD19+ cells were assessed. All patients were in partial remission on therapy. The absolute count of CD19+ B cells showed a statistically significant decline (P = .006). The percentage of CD4 + T lymphocytes increased 2 weeks after injection and decreased 2 weeks later (P = .01). The average number and size of lesions decreased. The concentration of anti-Dsg 3 antibody decreased insignificantly during the study. The severe pain during the injection was considered as the main complication. At the end of the study, two patients were in complete remission on therapy, and the other nine remained in partial remission on therapy. Few side effects resulting from intralesional injection of RTX and enhanced quality of life of the patients were considered as the valuable achievements of this study. The results showed that although a low dose of RTX leads to a significant decrease of CD19+ B lymphocytes, it did not show parallel clinical effectiveness.
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Affiliation(s)
- Ebrahim Mazloom
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kamran Balighi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Moradi Ketisari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Vahid Eslami Faresani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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21
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Nili A, Mahmoudi H, Heidari N, Tavakolpour S, Salehi Farid A, Balighi K, Daneshpazhooh M. Rituximab monotherapy in mild pemphigus. J DERMATOL TREAT 2020; 33:1784-1786. [PMID: 33040641 DOI: 10.1080/09546634.2020.1836309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikta Heidari
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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22
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Amir Dastmalchi D, Moslemkhani S, Bayat M, Balighi K, Abedini R, Mahmoudi H, Daneshpazhooh M. The efficacy of rituximab in patients with mucous membrane pemphigoid. J DERMATOL TREAT 2020; 33:1084-1090. [PMID: 32723108 DOI: 10.1080/09546634.2020.1801974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder with tendency to scarring. Long term immunosuppressive treatment may be required to minimize the consequences of the disease. METHODS In this retrospective study, we investigated the efficacy of rituximab (RTX) in MMP patients and compare the beneficial effects of early versus late administration of RTX. Medical records of 24 MMP patients who were treated with 500 mg RTX on day 1, then weekly for 4 consecutive weeks were reviewed. RESULTS Twenty-one patients (87.5%) reached disease control (DC) at the mean interval of 4.95 months (SD: 5.15; range: 1-24) after RTX. Complete remission (CR) with scarring was achieved in 45.8% (n = 11) and 33.3% (n = 8) attained CR without any residual scar (total CR with or without scar 79.1%). Two patients (8.3%) reached partial remission including persistent gingivitis. Only one patient progressed from non-cicatricial to cicatricial MMP despite receiving RTX. 47.6% (n = 10) of patients experienced relapse after achieving DC at a mean interval of 15.2 months (range: 6-30, SD: 7.0). Considerably, earlier the RTX was administered, sooner the DC was obtained (Pearson r = 0.742, p-value < .001). CONCLUSIONS These results suggest that RTX may prevent further scarring and progression in MMP patients especially if administered early.
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Affiliation(s)
- Delara Amir Dastmalchi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Moslemkhani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bayat
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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23
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Kianfar N, Dasdar S, Mahmoudi H, Tavakolpour S, Balighi K, Daneshpazhooh M. Rituximab in childhood and juvenile autoimmune bullous diseases as first-line and second-line treatment: a case series of 13 patients. J DERMATOL TREAT 2020; 33:869-874. [DOI: 10.1080/09546634.2020.1788702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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24
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Di Lernia V, Casanova DM, Goldust M, Ricci C. Pemphigus Vulgaris and Bullous Pemphigoid: Update on Diagnosis and Treatment. Dermatol Pract Concept 2020; 10:e2020050. [PMID: 32642305 DOI: 10.5826/dpc.1003a50] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Autoimmune bullous disorders are a heterogeneous spectrum of skin disorders characterized by the production of autoantibodies against adhesion molecules of the skin. The 2 major groups of diseases are "pemphigus diseases" and "autoimmune bullous diseases of the pemphigoid type." Pemphigus diseases are a group of autoimmune blistering diseases of the skin and mucous membranes characterized by intraepithelial cleft and acantholysis. The main subtypes of pemphigus include pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus. Diagnosis is based on clinical manifestations and confirmed with histological, immunofluorescence, and serological testing. Recently multivariant enzyme-linked immunosorbent assay systems have been developed as practical screening tools for patients with suspected autoimmune bullous dermatoses. The current first-line treatment of pemphigus is based on systemic corticosteroids that are often combined with immunosuppressive adjuvants, such as azathioprine, mycophenolate mofetil, and the anti-CD20 monoclonal antibody rituximab, usually at initiation of treatment. Rituximab efficacy is higher when it is administered early in the course of the disease. Therefore, it should be used as first-line treatment to improve efficacy and reduce cumulative doses of corticosteroids and their side effects. Treatment of bullous pemphigoid is based on disease extension. Localized and mild forms can be treated with superpotent topical corticosteroids or with nonimmunosuppressive agents. In patients with generalized disease or whose disease is resistant to the treatments described above, systemic corticosteroids are preferred and effective. Adjuvant immunosuppressants are often combined with steroids for their steroid-sparing effect.
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Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Dahiana M Casanova
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Mohamad Goldust
- University Guglielmo Marconi, Rome, Italy & Department of Dermatology, University Hospital, Basel, Switzerland
| | - Cinzia Ricci
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
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Nili A, Tavakolpour S, Mahmoudi H, Noormohammadpour P, Balighi K, Daneshpazhooh M. Paradoxical reaction to rituximab in patients with pemphigus: a report of 10 cases. Immunopharmacol Immunotoxicol 2020; 42:56-58. [DOI: 10.1080/08923973.2020.1717526] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Noormohammadpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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