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Abstract
Pemphigus forms a group of rare autoimmune bullous diseases that affect the skin and mucous membranes. This group has a chronic course leading to high morbidity and mortality. It is characterized by the production of pathogenic autoantibodies directed against different proteins of the desmosome, leading histologically to intraepidermal cleavage, and clinically to vesicles and erosions on the epithelium of the mucous membranes and/or the skin. The diagnosis of the subtype of pemphigus is based on clinical features, the level of histologic cleavage, and the identification of the antigens recognized by circulating autoantibodies by immunoserological analyses. The epidemiological features of pemphigus vary considerably in different regions of the world. Observational studies examining comorbidities and associations among patients with pemphigus are scarce and sometimes inconclusive. The prognosis, mortality, and clinical outcomes in pemphigus have undergone dramatic change throughout the years. This review provides a brief overview about the different subtypes of pemphigus: pemphigus vulgaris, pemphigus foliaceus, paraneoplastic pemphigus, pemphigus herpetiformis, and IgA pemphigus. In addition, it summarizes the most recent understanding of the epidemiology, mortality data, and comorbidities of this group of organ-specific autoimmune diseases.
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Kridin K, Kridin M, Shalom G, Cohen AD. The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis. Immunol Res 2018; 67:134-141. [PMID: 30338449 DOI: 10.1007/s12026-018-9031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is little consensus regarding the association between pemphigus and psoriasis. The aim of the current study is to synthesize existing data on the prevalence of psoriasis in patients with pemphigus and on the association between the two conditions. We performed a systematic review and meta-analysis of observational studies in Medline, Embase, and Web of Science (1900-2018). Reference lists of included studies were also searched for eligible studies. Quality of evidence was assessed using Newcastle-Ottawa scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled prevalence rates and odds ratios (ORs) with 95% confidence intervals (CI). Subgroup and sensitivity analyses were also conducted. Twelve eligible studies comprising 12,238 patients with pemphigus were included in the quantitative synthesis. The overall random-effects pooled prevalence of psoriasis among patients with pemphigus was 2.4% (95% CI, 1.0-4.4) across all studies. The overall pooled multivariate OR for psoriasis in patients with pemphigus was significantly increased and estimated at 3.5 (95% CI, 1.6-7.6). In conclusion, a significant association was found between pemphigus and psoriasis. Physicians managing patients with pemphigus may be aware of this comorbidity. Further studies are warranted to establish the precise mechanisms underlying this relationship.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, POB 9602, 31096, Haifa, Israel.
| | - Mouhammad Kridin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Shalom
- Clalit Health Services, Yavne, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Dainichi T, Kabashima K. Interaction of Psoriasis and Bullous Diseases. Front Med (Lausanne) 2018; 5:222. [PMID: 30135860 PMCID: PMC6092515 DOI: 10.3389/fmed.2018.00222] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/20/2018] [Indexed: 12/26/2022] Open
Abstract
Patients with psoriasis are frequently complicated with autoimmune bullous diseases, especially, pemphigoid diseases. It has been known that one-third cases of anti-laminin gamma1 pemphigoid, formerly anti-p200 pemphigoid, are associated with psoriasis whereas bullous pemphigoid is the most frequently associated bullous disease in psoriasis cases regardless of the lack of detectable levels of the accompanying anti-laminin gamma1 autoantibodies. Despite several suggestions, however, the definitive reason of the striking association of psoriasis and these autoimmune bullous diseases remains elusive. In this review, we look over the epidemiological evidence of the association of psoriasis and autoimmune bullous diseases and the information of genetic susceptibilities of each disease, and discuss the possible mechanisms of their complication with reference to the recent understandings of each pathogenesis.
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Affiliation(s)
- Teruki Dainichi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Singapore Immunology Network and Institute of Medical Biology, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
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Timóteo RP, Silva MV, da Silva DAA, Catarino JDS, Alves FHC, Rodrigues Júnior V, Roselino AM, Sales-Campos H, Oliveira CJF. Cytokine and Chemokines Alterations in the Endemic Form of Pemphigus Foliaceus (Fogo Selvagem). Front Immunol 2017; 8:978. [PMID: 28855908 PMCID: PMC5557772 DOI: 10.3389/fimmu.2017.00978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/31/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The endemic form (fogo selvagem-FS) of pemphigus foliaceus is an autoimmune disease characterized by the presence of IgG autoantibodies against desmoglein-1. Despite the array of findings, the role of chemokines and cytokines that dictate the immune response and disease outcome is still poorly investigated. MATERIALS AND METHODS Serum from 64 patients diagnosed with FS was used to draw and establish the levels of these molecules on this disease and establish the levels of these molecules with the severity of FS, and influence of treatment. RESULTS In comparison to healthy subjects, FS patients, newly diagnosed and still without therapeutic intervention, had higher levels of IL-22 and CXCL-8, and reduced levels of IFN-γ, IL-2, IL-15, and CCL-11. Furthermore, treatment using immunosuppressant drugs augmented the production of IFN-γ, IL-2, CCL-5, and CCL-11 besides reducing the levels of IL-22 and CXCL-10. Immunosuppressive therapy seemed to have long-lasting effects on the production of higher amounts of IFN-γ, IL-2, and CCL-5, besides keeping lowered the levels of IL-22 in remission FS patients. CONCLUSION Taken together, our findings suggest a putative role of IL-22 in the pathogenesis of FS. Finally, data presented here may contribute for better understanding the immune aspects that control disease outcome.
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Affiliation(s)
- Rodolfo Pessato Timóteo
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcos Vinicius Silva
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Djalma Alexandre Alves da Silva
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Jonatas Da Silva Catarino
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Fernando Henrique Canhoto Alves
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Virmondes Rodrigues Júnior
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Ana Maria Roselino
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helioswilton Sales-Campos
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Carlo José Freire Oliveira
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Daneshpazhooh M, Fatehnejad M, Rahbar Z, Balighi K, Ghandi N, Ghiasi M, Abedini R, Lajevardi V, Chams-Davatchi C. Trauma-induced pemphigus: a case series of 36 patients. J Dtsch Dermatol Ges 2016; 14:166-71. [PMID: 26819113 DOI: 10.1111/ddg.12738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Pemphigus is a group of autoimmune diseases characterized by intraepidermal acantholytic blisters. Isomorphic responses, or Koebner phenomenon (KP), defined as the appearance of typical lesions of a disease following trauma are rarely reported in pemphigus. Our aim was to present patients who developed new pemphigus lesions as a result of skin trauma. PATIENTS AND METHODS The medical files of pemphigus patients from the Autoimmune Bullous Diseases Research Center, who had a history of trauma before the onset or flare of their disease, between 1999 and 2013 were reviewed. RESULTS Thirty-six pemphigus vulgaris (PV) patients had a history of trauma. Thirteen patients developed new-onset PV and the other 23 had previously been diagnosed with PV. Pemphigus lesions developed most often following major surgeries including abdominal, orthopedic, and chest surgeries as well as dental procedures, blunt physical trauma, and skin surgeries. Moreover, post-cataract laser surgery, burns, radiation therapy, and physiotherapy were also shown to induce pemphigus. Mean time between trauma and lesions was 4.7 weeks for recurrent PV and 15.0 weeks for new-onset PV. CONCLUSIONS Unnecessary surgery and blunt trauma should be avoided in pemphigus patients. Furthermore, posttraumatic pemphigus should be suspected in poorly healing surgical wounds and confirmatory biopsies are mandatory.
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Affiliation(s)
- Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Fatehnejad
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ziba Rahbar
- 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
| | - Narges Ghandi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghiasi
- 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
| | - Vahideh Lajevardi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Cheyda Chams-Davatchi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Daneshpazhooh M, Fatehnejad M, Rahbar Z, Balighi K, Ghandi N, Ghiasi M, Abedini R, Lajevardi V, Chams-Davatchi C. Trauma-induzierter Pemphigus: eine Fallserie von 36 Patienten. J Dtsch Dermatol Ges 2016. [DOI: 10.1111/ddg.140_12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Mina Fatehnejad
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Ziba Rahbar
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Narges Ghandi
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Maryam Ghiasi
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Vahideh Lajevardi
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
| | - Cheyda Chams-Davatchi
- Autoimmune Bullous Diseases Research Center; Tehran University of Medical Sciences; Teheran Iran
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Kwon HH, Kwon IH, Chung JH, Youn JI. Pemphigus Foliaceus Associated with Psoriasis during the Course of Narrow-Band UVB Therapy: A Simple Coincidence? Ann Dermatol 2011; 23:S281-4. [PMID: 22346257 PMCID: PMC3276776 DOI: 10.5021/ad.2011.23.s3.s281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/18/2010] [Accepted: 08/18/2010] [Indexed: 12/25/2022] Open
Abstract
Although psoriasis and bullous diseases are considered to be completely different disease entities, the literature has reported a few cases of psoriasis associated with bullous diseases, most of which are bullous pemphigoid. In limited cases, pemphigus foliaceus has also been reported in association with psoriasis. In most of them, pemphigus lesions usually developed on an untreated patient with a chronic history of psoriasis. Herein, we report a case of 53-year-old male with a chronic history of psoriasis who first developed generalized erosive lesions after 26 cycles of narrow-band ultraviolet B (NBUVB) therapy. A diagnosis of pemphigus foliaceus was made based on skin biopsy and direct immunofluorescence assay. Pemphigus lesions were well controlled with combination therapy of oral steroid and azathioprine. This is the first case where pemphigus foliaceus co-occurred with psoriasis during NBUVB therapy.
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Affiliation(s)
- Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Sanchez-Palacios C, Chan LS. Development of pemphigus herpetiformis in a patient with psoriasis receiving UV-light treatment. J Cutan Pathol 2004; 31:346-9. [PMID: 15005694 DOI: 10.1111/j.0303-6987.2004.0188.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus is an autoimmune blistering disease of the skin and mucous membranes. Pemphigus herpetiformis, a rare variant of pemphigus, is characterized by erythematous, vesicular, bullous, or papular lesions in a herpetiform pattern, often associated with pruritus. Clinical cases documenting the development of pemphigus in patients with a history of psoriasis have been reported in the literature. METHODS We used immunological methods to study a case in which pemphigus herpetiformis occurred in a woman with a history of psoriasis, shortly after a course of ultraviolet B (UVB) therapy. RESULTS Histopathology revealed a subcorneal blister with prominent neutrophilic infiltration. Immunopathology detected in situ bound and circulating immunoglobulin G (IgG) autoantibodies to epithelial cell surfaces and circulating IgG autoantibodies against desmoglein 1. The patient was also found to have Hashimoto's thyroiditis. CONCLUSIONS This case illuminates a possible role of UV therapy in the induction of pemphigus herpetiformis through an epitope-spreading mechanism. The patient's autoimmune thyroiditis may also contribute to the predisposition for pemphigus development. The histopathological findings in pemphigus patients with a history of psoriasis may resemble Munro's microabscesses of psoriasis and should therefore alert pathologists and clinicians in considering additional diagnostic methods such as direct and indirect immunofluorescence.
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Affiliation(s)
- Carla Sanchez-Palacios
- Department of Dermatology, Northwestern University Medical School, Chicago, IL 60612, USA
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Abstract
The intent and purpose of the authors is to familiarize the reader with the principles that govern the diagnosis and management of autoimmune mucocutaneous blistering diseases. The purpose was not to be all-inclusive but illustrative. There are several other blistering diseases that have not been discussed because of the limited scope of this article. Of these, toxic epidermal necrolysis, erythema multiforme, and the like warrant the same attention and early recognition. These are covered in different articles. For the same reasons, certain genetically linked blistering diseases have not been discussed.
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MESH Headings
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/physiopathology
- Child
- Dermatitis Herpetiformis/diagnosis
- Dermatitis Herpetiformis/drug therapy
- Diagnosis, Differential
- Epidermolysis Bullosa Acquisita/diagnosis
- Epidermolysis Bullosa Acquisita/drug therapy
- Female
- Humans
- Immunoglobulin A/analysis
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Pemphigoid Gestationis/diagnosis
- Pemphigoid Gestationis/drug therapy
- Pemphigoid, Benign Mucous Membrane/diagnosis
- Pemphigoid, Benign Mucous Membrane/drug therapy
- Pemphigoid, Bullous/diagnosis
- Pemphigoid, Bullous/drug therapy
- Pemphigus/classification
- Pemphigus/diagnosis
- Pemphigus/drug therapy
- Pregnancy
- Prognosis
- Skin Diseases, Vesiculobullous/diagnosis
- Skin Diseases, Vesiculobullous/drug therapy
- Skin Diseases, Vesiculobullous/immunology
- Skin Diseases, Vesiculobullous/physiopathology
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Affiliation(s)
- J E Scott
- Department of Medicine, New England Baptist Hospital, Boston, Massachusetts, USA
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