1
|
Garza-Dávila VF, Santana-Gutiérrez A, Zapata-Salazar N, Vázquez-Martínez O, Ocampo-Candiani J, Fernández-de Luna ML, Mohamed-Noriega K, Alba-Rojas E. Eye and lid involvement as an uncommon feature of pemphigus foliaceus in a pediatric patient. Pediatr Dermatol 2024. [PMID: 38459607 DOI: 10.1111/pde.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
Pemphigus foliaceus (PF) is an autoimmune blistering disorder which affects the superficial layers of the epidermis with rare mucosal involvement. We present the case of a 12-year-old girl with PF involving the eyes and eyelids. A literature review of pediatric nonendemic PF revealed another two cases with ocular manifestations. Eyelid involvement is an uncommon feature of PF that should be properly identified and treated.
Collapse
Affiliation(s)
- Valeria F Garza-Dávila
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Adalberto Santana-Gutiérrez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Natalia Zapata-Salazar
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Osvaldo Vázquez-Martínez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Marissa L Fernández-de Luna
- Ophthalmolgy Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Karim Mohamed-Noriega
- Ophthalmolgy Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Erika Alba-Rojas
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| |
Collapse
|
2
|
Nguyen TTD, Chau TNT, Doan Vo PT, Nguyen HT. Sporadic Pemphigus Foliaceus in a 3-Year-Old Vietnamese Girl: A Case Report and Literature Review. Case Rep Dermatol Med 2024; 2024:6748340. [PMID: 38404530 PMCID: PMC10890903 DOI: 10.1155/2024/6748340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/20/2023] [Accepted: 02/10/2024] [Indexed: 02/27/2024] Open
Abstract
Pemphigus foliaceus is an uncommon autoimmune intraepidermal blistering disease characterized by immunoglobulin (Ig) G autoantibodies that attack desmoglein-1 in the epidermis. There are two predominant forms of pemphigus foliaceus, sporadic and endemic. Sporadic pemphigus foliaceus is known to be more prevalent in middle-aged and elderly people and to be extremely rare in children. Less than 40 nonendemic pediatric pemphigus foliaceus cases have been documented in the literature. This report documents a case of sporadic pemphigus foliaceus in a 3-year-old Vietnamese girl who presented with generalized scaling and crusted erosions over the body.
Collapse
Affiliation(s)
| | - Trinh Ngoc To Chau
- Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City, Vietnam
| | - Phuong Thi Doan Vo
- Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City, Vietnam
| | - Hao Trong Nguyen
- Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| |
Collapse
|
3
|
Carver C, Kalesinskas M, Dheden N, Ahmed AR. Treatment of Pediatric Pemphigus Foliaceus. Cureus 2023; 15:e45373. [PMID: 37779684 PMCID: PMC10533949 DOI: 10.7759/cureus.45373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Pemphigus foliaceus (PF) is an autoimmune blistering disease limited to the superficial skin without mucosal involvement. It is clinically, histologically, and immunopathologically distinct from pemphigus vulgaris (PV). As data on pediatric PF is often merged with data on both pediatric and adult PV patients, isolating clinical outcomes in pediatric PF is not always possible. Therefore, the authors of this review analyzed clinical outcomes following therapy in pediatric PF patients only. A search of databases resulted in 33 pediatric patients with PF. In total, 19 (57.6%) patients were treated with conventional immunosuppressive therapies (CISTs), which consisted of systemic corticosteroids and multiple immunosuppressive agents (ISAs). Further, 14 (42.4%) patients were treated with biologic agents, predominantly rituximab (RTX). The mean age of those treated with biologics was 12.8 years (range = 0.88-18 years) compared to 8.9 years (range = 0.92-15 years) of those treated with CIST (p = 0.01). Treatment with biologics was initiated significantly longer after the diagnosis of PF when compared to patients treated with CIST (p = 0.003). RTX was used in all patients who received biologic therapy. Two (6%) patients also received intravenous immunoglobulin. When clinical outcomes were compared between CIST and biologic therapy, rates of clinical remission, partial remission, and relapse, were not statistically significantly different between groups. When RTX was used, rates of relapse and adverse events were higher in those treated with the lymphoma protocol (375 mg/m2 once weekly for four weeks) compared to those treated with the rheumatoid arthritis protocol (two doses of 1,000 mg two weeks apart) (p < 0.0001). The incidence of adverse events was statistically significantly higher in patients treated with CIST when compared to RTX (p = 0.003). These included both physical and psychological changes. The infection rate after treatment with RTX was 7.1%. These outcomes occurred during a follow-up of 12.5 months (range = 1-36 months) in the CIST group and 20.5 months (range = 6-67 months) in the biologic therapy group. The difference in the follow-up period was not statistically significant. The literature suggests that biologics are superior to CIST in treating pemphigus patients. The results of this review suggest similar responses to therapy in pediatric PF patients treated with biologics compared to CIST. This may have been due to a limited duration of follow-up and a lack of detailed treatment outcomes in pediatric PF patients. The data in this review strongly suggests that specific treatment protocols need to be developed and implemented for pediatric PF patients. These patients are at a critical phase in life where PF therapy can influence or affect physical growth, hormonal changes, psychosocial development, and essential education.
Collapse
Affiliation(s)
- Caden Carver
- Dermatology, Midwestern University Arizona College of Osteopathic Medicine, Glendale, USA
| | - Mikole Kalesinskas
- Department of Dermatology, Tufts University School of Medicine, Center for Blistering Diseases, Boston, USA
| | - Ngawang Dheden
- Department of Dermatology, Barts and the London School of Medicine, Queen Mary University, London, GBR
| | - A Razzaque Ahmed
- Department of Dermatology, Tufts University School of Medicine, Center for Blistering Diseases, Boston, USA
| |
Collapse
|
4
|
Rao B, Trager JD, Nossa R, Granstein RD, Scott RA. Blistering Disorder in a 30-Month-Old Boy. J Cutan Med Surg 2016. [DOI: 10.1177/120347549700200109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Babar Rao
- Department of Dermatology, The New York Hospital—Cornell Medical Center, New York, New York
| | - Jonathan D.K. Trager
- Department of Dermatology, The New York Hospital—Cornell Medical Center, New York, New York
| | - Robert Nossa
- Department of SUNY at Stony Brook Medical Center, Stony Brook, New York
| | - Richard D. Granstein
- Department of Dermatology, The New York Hospital—Cornell Medical Center, New York, New York
| | - Rachelle A. Scott
- Department of Dermatology, The New York Hospital—Cornell Medical Center, New York, New York
| |
Collapse
|
5
|
Abstract
BACKGROUND Pemphigus foliaceus is a cutaneous, autoimmune, blistering disease comprising two major categories: endemic and sporadic. The endemic form, also known as fogo selvagem, primarily affects children and young adults in rural Brazil. In contrast, the sporadic form of pemphigus foliaceus is generally a disease of the middle-aged and elderly. OBJECTIVE AND METHODS Because the sporadic form of pemphigus foliaceus rarely affects children, information specific to this unique group is lacking. We describe a 3-year-old boy with the disease and retrospectively review data from 28 past cases. RESULTS In comparison to pediatric cases of pemphigus vulgaris, sporadic pemphigus foliaceus in children tends to follow a generally benign course of relatively short duration. However, long-term outcome studies are lacking. A pattern of skin lesions described as "arcuate," "circinate," or "polycyclic" appears to be a unique and specific presentation of this disease in children. Occasionally, as in our case, the diagnosis may prove difficult to establish by using routine histology or immunopathology. CONCLUSION The commercial availability of antigen-specific techniques such as enzyme-linked immunosorbent assay for serum desmoglein 1 autoantibody should eliminate delay in diagnosis. Hydroxychloroquine may be another treatment option for those children with photodistributed lesions. Further experience and long-term outcome studies in children are needed to determine whether some medication side effects may outweigh the risks from the disease itself.
Collapse
Affiliation(s)
- Denise W Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fasnnin Street, MC 3-3315, Houston, TX 77030-2399, USA.
| | | | | |
Collapse
|
6
|
Brenner S, Mashiah J. Autoimmune blistering diseases in children: signposts in the process of evaluation. Clin Dermatol 2000; 18:711-24. [PMID: 11173206 DOI: 10.1016/s0738-081x(00)00154-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Brenner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | |
Collapse
|
7
|
Affiliation(s)
- E A Strauss
- Department of Dermatology, New York Weil Cornell Center of The New York Presbyterian Hospital, New York, New York 10021, USA
| | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Five children with pemphigus are reported: three with pemphigus vulgaris, one with pemphigus vegetans, and one with pemphigus foliaceus. Only one case of juvenile pemphigus vegetans has been published in the literature. MATERIALS AND METHODS All three patients with pemphigus vulgaris were treated with oral corticosteroid; in two cases, azathioprine was added for steroid-sparing effect. The patient with pemphigus vegetans had a clinical presentation resembling pemphigus vulgaris, but the lesions in the perianal area healed as hypertrophic granulation tissue. He was treated with oral corticosteroid, azathioprine, and intralesional corticosteroid. The patient with pemphigus foliaceus presented with exfoliative dermatitis, and was treated with oral corticosteroid; methotrexate was added later for steroid-sparing purposes RESULTS The patients were followed up for 1-4 years; the prognosis of childhood pemphigus is good. CONCLUSIONS Long-term follow-up is needed to detect flaring of the disease and the side-effects of immunosuppressive drugs.
Collapse
Affiliation(s)
- S Wananukul
- Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
9
|
Abstract
A 7-year-old girl with generalized erythematous, scaling plaques and vesiculobullous lesions on the extremities was diagnosed as having pemphigus foliaceus. Lesional direct immunofluorescence revealed intercellular IgG, IgA and C3 deposition. The patient's serum gave positive reactions against one epitope of desmoglein 3 and the epitope of desmoglein 1 in enzyme-linked immunosorbent assays, but the blood sample for indirect immunofluorescence did not display any circulating antibodies. The patient was successfully treated systemically with prednisolone and dapsone. Currently, she is taking dapsone, 12.5 mg daily. She has been free of lesions for the last 3 years.
Collapse
Affiliation(s)
- M Mehravaran
- Department of Dermatology, Albert Szent-Györgyi Medical University, H-6701 Szeged, Korányi fasor 6, PO Box 480, Szeged, Hungary.
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Pemphigus foliaceus is a skin disease in which antibodies against the cell surface of keratinocytes destroy the adhesion between epidermal cells, thereby producing blisters. It is a rare disease in childhood, and treatment guidelines for juvenile pemphigus foliaceus are lacking. An 8 year old boy with pemphigus foliaceus is described. He did not respond to topical steroids, and the condition flared up when high dose oral steroids were tapered. The lesions resolved completely in four weeks on dapsone, which was maintained for nine months with no major adverse effects, except for a moderate increase of the methaemoglobin concentration at the outset of treatment. There has been no evidence of disease reactivation in more than nine months of follow up since dapsone withdrawal.
Collapse
|
11
|
Abstract
Autoimmune blistering diseases are relatively rare in children and adolescents. LADC and DH are the most often seen of these conditions and respond well to therapy. Some newly recognized diseases have been reported in children including localized vulvar pemphigoid, intraepidermal neutrophilic IgA dermatosis, and paraneoplastic pemphigus.
Collapse
Affiliation(s)
- M J Rico
- Ronald O. Perelman Department of Dermatology, New York University, NY, USA
| |
Collapse
|