1
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Kimura A, Makino T, Kitayama S, Mizawa M, Ishii N, Hashimoto T, Shimizu T. Immunohistopathological analyses of a case of pemphigus vegetans with antibodies against desmoglein 1 and desmocollins 1-3. J Dermatol 2024. [PMID: 39073162 DOI: 10.1111/1346-8138.17410] [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: 04/30/2024] [Revised: 06/15/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Pemphigus vegetans is a rare type of pemphigus characterized by vegetative lesions primarily localized to the intertriginous area. Despite its unique clinical presentation, the underlying pathomechanism remains unclear owing to the rarity of the disease. We report a case of pemphigus vegetans with antibodies against desmoglein 1 and desmocollins 1-3. Furthermore, immunohistochemical analyses were performed to address the pathogenesis of this disease. A 73-year-old man presented with multiple vegetative plaques with erythema on the trunk, groins, and extremities. Mucosal lesions were not observed. Laboratory examinations revealed mild leukocytosis with eosinophilia. A histopathological examination of the skin lesion showed epidermal hyperplasia and intraepidermal abscesses with marked infiltration of neutrophils and eosinophils, and infiltration of lymphocytes and eosinophils into the upper derms. Bacterial culture of the skin tissue was positive for Staphylococcus aureus. Direct immunofluorescence showed deposits of IgG and C3 on keratinocyte surfaces in the epidermis. Autoantibodies against desmoglein 1 and autoantibodies against desmocollin 1, desmocollin 2, and desmocollin 3 were detected by enzyme-linked immunosorbent assays. The diagnosis of pemphigus vegetans was made. Initiation of prednisolone (1.0 mg/kg/day) gradually improved his skin symptoms. We performed immunohistochemical analyses of the lesional skin, which revealed infiltration of CD3-positive, CD4-positive, and CD68-positive cells in the upper dermis, but CD20- or CD56-positive cells were negative. In addition, the present case showed more prominent infiltration of IL-17A- and IL-22-positive cells in the upper dermis than in pemphigus foliaceus, a type of pemphigus with autoantibodies against desmoglein 1. Furthermore, these cells co-expressed CD3 and CD68. We hypothesized that IL-22 and IL-17A produced by T cells and macrophages and their dysregulation might be involved in the pathogenesis of pemphigus vegetans. Additionally, skin colonization and/or infection with Staphylococcus aureus could potentially contribute to the pathogenesis of the disease.
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Affiliation(s)
- Anri Kimura
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Teruhiko Makino
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shohei Kitayama
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Megumi Mizawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tadamichi Shimizu
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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2
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Muñoz de Toro M, Masatkar V, Blankenship HT, Ahn C, Sangüeza OP. Chronic Painful Vegetative Plaques on the Buttocks: Answer. Am J Dermatopathol 2024; 46:397-398. [PMID: 39121203 DOI: 10.1097/dad.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Affiliation(s)
| | - Vaishali Masatkar
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC; and
| | | | - Christine Ahn
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Omar Pastor Sangüeza
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC; and
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3
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Errichetti E, Lallas A, Galvan A. Dermoscopy of condyloma lata: An observational controlled study. Australas J Dermatol 2023; 64:e381-e383. [PMID: 37706598 DOI: 10.1111/ajd.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Enzo Errichetti
- Institute of Dermatology, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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4
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Kakurai M, Oya K, Furuta J, Iijima S, Nomura T. A Case of Eosinophilic Pustular Folliculitis with Vegetating Lesions on the Lower Legs and Feet Resembling Pemphigus Vegetans. Acta Derm Venereol 2023; 103:adv11622. [PMID: 37083096 PMCID: PMC10134064 DOI: 10.2340/actadv.v103.11622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/22/2023] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Masakazu Kakurai
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazumasa Oya
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Junichi Furuta
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shigeruko Iijima
- Department of Dermatology, Ryugasaki Saiseikai Hospital, Ibaraki, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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5
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Kawamura T, Muramatsu K, Orita A, Mai Y, Sugai T, Haga N, Fujimura Y, Miyauchi T, Izumi K, Koga H, Ishii N, Ujiie H. Two cases of Hallopeau-type pemphigus vegetans with anti-desmoglein 1 and anti-desmocollin 3 antibodies without mucosal involvement. J Eur Acad Dermatol Venereol 2023; 37:e508-e510. [PMID: 36305887 DOI: 10.1111/jdv.18704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Takuya Kawamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ken Muramatsu
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiro Orita
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuro Sugai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Haga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yu Fujimura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshinari Miyauchi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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6
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Le ST, Toussi AM, Nava JE, Downing LA, Fung MA. Case report: Mounded and refractory keratoses (MARK), a novel presentation of pemphigus vulgaris. Front Med (Lausanne) 2023; 9:1087382. [PMID: 36703899 PMCID: PMC9871614 DOI: 10.3389/fmed.2022.1087382] [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] [Received: 11/02/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Pemphigus vulgaris (PV) is a rare immunobullous disease. Although it classically presents as generalized flaccid blisters affecting the skin and mucosae, atypical cases of PV can be diagnostically challenging. Herein, we report an underrecognized non-blistering manifestation of pemphigus vulgaris, which we call mounded and refractory keratoses (MARK). MARK presents as exuberant scaling plaques on the scalp, often in the skin of color. When MARK features are present, pemphigus vulgaris is prone to misdiagnosis, clinically and histopathologically, leading to delays in appropriate treatment. Specifically, biopsies from these patients may resemble acantholytic dyskeratosis, resulting in initial misdiagnosis. Thus, recognizing this presentation may aid physicians in diagnosing and monitoring the recurrence of pemphigus vulgaris.
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Affiliation(s)
- Stephanie T. Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States,*Correspondence: Stephanie T. Le,
| | - Atrin M. Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Jordan E. Nava
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Lauren A. Downing
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Maxwell A. Fung
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States,Department of Pathology, University of California, Davis, Sacramento, CA, United States
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7
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Siadat AH, Moeine R, Iraji F, Galehdari H, Shahriarirad R. Pemphigus vegetans misdiagnosed as condylomata acuminata: A case report. Clin Case Rep 2022; 10:e6393. [PMID: 36258762 PMCID: PMC9575105 DOI: 10.1002/ccr3.6393] [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: 04/30/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
Pemphigus vegetans is a rare variant of pemphigus vulgaris, characterized by vegetating lesions primarily in the flexures. A 41-year-old male patient presented with pemphigus vegetans highly mimicking condylomata acuminata, which led to mistreatment. Careful analysis of clinical and laboratory findings enabled us to reach a correct diagnosis and successful treatment.
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Affiliation(s)
- Amir Hossein Siadat
- Department of Dermatology, Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Reza Moeine
- Department of Dermatology, Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Fariba Iraji
- Department of Dermatology, Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Hamid Galehdari
- Department of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical SciencesShirazIran
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8
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Epidemiologic Study of Patients with Chronic Vesiculobullous Lesions. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Tekin B, Johnson EF, Wieland CN, Gibson LE, Camilleri MJ, Kalaaji AN, Comfere NI, Peters MS, Lehman JS. Histopathology of autoimmune bullous dermatoses: What's new? Hum Pathol 2022; 128:69-89. [PMID: 35764145 DOI: 10.1016/j.humpath.2022.06.021] [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: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
Autoimmune bullous dermatoses are characterized by the presence of tissue-bound and often circulating pathogenic autoantibodies targeting structural components of the skin and/or mucous membranes. The diagnostic workup for this heterogeneous group of disorders consists of a multi-step process, of which the light microscopic examination is a crucial component. This review is organized following a classification scheme that is based on two main histopathologic features, namely level of intraepithelial split and composition of the inflammatory infiltrate. Overall, we aim to place emphasis on the histopathologic clues that can assist pathologists in differential diagnosis and review the updates in the literature.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emma F Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Carilyn N Wieland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lawrence E Gibson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Camilleri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Amer N Kalaaji
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Nneka I Comfere
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Margot S Peters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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10
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Lim YL, Bohelay G, Hanakawa S, Musette P, Janela B. Autoimmune Pemphigus: Latest Advances and Emerging Therapies. Front Mol Biosci 2022; 8:808536. [PMID: 35187073 PMCID: PMC8855930 DOI: 10.3389/fmolb.2021.808536] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Pemphigus represents a group of rare and severe autoimmune intra-epidermal blistering diseases affecting the skin and mucous membranes. These painful and debilitating diseases are driven by the production of autoantibodies that are mainly directed against the desmosomal adhesion proteins, desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1). The search to define underlying triggers for anti-Dsg-antibody production has revealed genetic, environmental, and possible vaccine-driven factors, but our knowledge of the processes underlying disease initiation and pathology remains incomplete. Recent studies point to an important role of T cells in supporting auto-antibody production; yet the involvement of the myeloid compartment remains unexplored. Clinical management of pemphigus is beginning to move away from broad-spectrum immunosuppression and towards B-cell-targeted therapies, which reduce many patients’ symptoms but can have significant side effects. Here, we review the latest developments in our understanding of the predisposing factors/conditions of pemphigus, the underlying pathogenic mechanisms, and new and emerging therapies to treat these devastating diseases.
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Affiliation(s)
- Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore
| | - Gerome Bohelay
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Sho Hanakawa
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Philippe Musette
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Baptiste Janela
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Immunology network, Agency for Science, Technology and Research (A*STAR), Singapore
- *Correspondence: Baptiste Janela,
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11
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Agon MKO, Mejia DND, Cifra CAP, Ramirez-Quizon M. Extensive pemphigus vegetans in a Filipino female. Int J Womens Dermatol 2022; 7:847-849. [PMID: 35028399 PMCID: PMC8714561 DOI: 10.1016/j.ijwd.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Mae Ramirez-Quizon
- Department of Dermatology, Rizal Medical Center, Manila, Philippines
- Department of Dermatology, Philippine General Hospital, Manila, Philippines
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12
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Marinović B, Miše J, Jukić IL, Bukvić Mokos Z. Pemphigus-The Crux of Clinics, Research, and Treatment during the COVID-19 Pandemic. Biomedicines 2021; 9:1555. [PMID: 34829784 PMCID: PMC8615103 DOI: 10.3390/biomedicines9111555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022] Open
Abstract
Pemphigus is a rare autoimmune disease characterised by the production of pathogenic autoantibodies in response to different desmosome proteins. The pathophysiological process leads to the development of blisters and erosions on mucosal and/or skin surfaces. The classical clinical variants of pemphigus are pemphigus vulgaris and pemphigus foliaceus. A diagnostic delay is very common in pemphigus, especially among patients with mucosal involvement. However, in recent years we have witnessed considerably fewer patients with extensive mucocutaneous manifestations, since patients with oral lesions are referred to dermatologists to start the treatment much sooner than they had been previously. Among non-classical variants of pemphigus, unusual cases with discrepancies between autoantibody profiles and clinics challenge the "desmoglein compensation theory". The identification of several other autoantigens that perform a role in the pathogenesis of different variants of pemphigus will progress immunodermatology towards an approach that will determine personalized pemphigus subtypes for each patient. Comorbidities among patients are primarily associated with the prolonged use of corticosteroids and other immunosuppressive agents. The SARS-CoV-2 pandemic raised concerns regarding the immunosuppressive effects of treatment and the risk of a more complicated COVID-19 infection, as well as on the ability to develop an adequate vaccine response.
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Affiliation(s)
- Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10000 Zagreb, Croatia; (B.M.); (I.L.J.)
| | - Joško Miše
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN)-Skin Reference Centre, Kišpatićeva 12, 10000 Zagreb, Croatia;
| | - Ines Lakoš Jukić
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10000 Zagreb, Croatia; (B.M.); (I.L.J.)
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Šalata 4, 10000 Zagreb, Croatia; (B.M.); (I.L.J.)
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13
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Qiu X, Yuan P, Li W, Jiang L. Post–cesarean section pemphigus vegetans in a young woman treated with methylprednisolone and thalidomide. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e62-e68. [DOI: 10.1016/j.oooo.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/06/2021] [Indexed: 02/06/2023]
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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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Radonjic-Hoesli S, Brüggen MC, Feldmeyer L, Simon HU, Simon D. Eosinophils in skin diseases. Semin Immunopathol 2021; 43:393-409. [PMID: 34097126 PMCID: PMC8241748 DOI: 10.1007/s00281-021-00868-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Eosinophil infiltration is a common finding in a broad spectrum of skin diseases, despite the fact that the skin is devoid of eosinophils under physiologic conditions. Although cutaneous eosinophilia is reactive, cytokine-mediated in most cases, diseases with an intrinsic mutation-mediated clonal expansion of eosinophils can also manifest on the skin. As eosinophils are involved in host defense, regulate immune responses, generate pruritus, induce remodeling and fibrosis, and can cause tissue damage, they have the capacity to actively contribute to the pathogenesis of diseases. Recent research provided deeper insights in the mechanisms, e.g., bacterial and viral clearance, blister formation, recruitment of cytotoxic T cells, and generation of pruritus, by which eosinophils might come into action. This review aims at providing an overview on the clinical presentations of eosinophil-associated dermatoses and the current understanding of their pathogenic role in these diseases. Further, we discuss the effects of therapies targeting eosinophils.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, Hochgebirgsklinik Davos, Davos, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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16
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Solimani F, Meier K, Zimmer CL, Hashimoto T. Immune serological diagnosis of pemphigus. Ital J Dermatol Venerol 2020; 156:151-160. [PMID: 33228340 DOI: 10.23736/s2784-8671.20.06788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pemphigus is a rare autoimmune blistering disease which manifests with painful erosions and blisters of the skin and mucosa. This disorder is caused by autoantibodies attacking desmosomal proteins, necessary for cell-cell contact stability and epidermal integrity. Desmoglein (Dsg) 1 and Dsg3 are the two major target antigens in pemphigus. Yet, many other target proteins, which have been described over the years, seem to be involved in the loss of epidermal integrity. Clinical examination, combined to serological advances and detection of targeted antigens, permitted to differentiate among several pemphigus subtypes, in which pemphigus vulgaris and pemphigus foliaceus are the most common. Nowadays, serological analysis in pemphigus is a fundamental step of the diagnostic algorithm. This is based on analysis of clinical symptoms, histopathological examination of lesional skin, detection of tissue bound and circulating antibodies by direct and indirect immunofluorescence, and determination of target antigens either by enzyme-linked immunosorbent essay (ELISA) or by western blot analysis. A correct and exhaustive diagnostic algorithm is fundamental to characterize pemphigus subtypes, which lastly permits to adopt a correct treatment approach. Moreover, quality and quantity of circulating antibodies in patient's sera deliver important information regarding clinical course, disease severity and treatment response; thus, relevantly affecting physician's decision. To facilitate this process, "easy-to-perform" diagnostic kits with high sensitivity and specificity are being commercialized. In this review, we focus on available methods and established assays to correctly detect circulating autoantibodies in pemphigus. Moreover, we discuss subtype specific serological peculiarities in the five most relevant subtypes (pemphigus vulgaris, pemphigus foliaceus, pemphigus vegetans, paraneoplastic pemphigus and intercellular IgA dermatosis (also called as IgA pemphigus).
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany -
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christine L Zimmer
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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17
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Tham HL, Linder KE, Olivry T. Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review. BMC Vet Res 2020; 16:457. [PMID: 33228633 PMCID: PMC7686683 DOI: 10.1186/s12917-020-02677-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is the term used to describe a group of rare mucocutaneous autoimmune bullous diseases characterized by flaccid blisters and erosions of the mucous membranes and/or skin. When the autoantibodies target desmosomes in the deep layers of the epidermis, deep pemphigus variants such as pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus develop. In this article, we will review the signalment, clinical signs, histopathology and treatment outcome of pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus in dogs, cats and horses; where pertinent, we compare the animal diseases to their human homologue. Canine, feline and equine pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus have many features similar to the human counterpart. These chronic and often relapsing autoimmune dermatoses require aggressive immunosuppressive therapy. In animals, the partial-to-complete remission of pemphigus vulgaris and pemphigus vegetans has been achieved with high dose glucocorticoid therapy, with or without adjunct immunosuppressants; the prognosis is grave for paraneoplastic pemphigus.
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Affiliation(s)
- Heng L. Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA USA
| | - Keith E. Linder
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
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18
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Steele L, Jeetle S, Kok K, Cunningham M, Goldsmith P. Pyodermatitis vegetans-pyostomatitis vegetans with ocular involvement. Clin Exp Dermatol 2020; 46:223-226. [PMID: 32975854 DOI: 10.1111/ced.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- L Steele
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Jeetle
- Department of, Histopathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Kok
- Department of, Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Cunningham
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - P Goldsmith
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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19
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Wang J, Wang X, Chen Y, Liu S, Song P. Is 640 nm high-fluence visible red light a valuable adjunct for treating pemphigus vegetans? A single case report. J Cosmet Dermatol 2020; 19:3234-3237. [PMID: 32359024 DOI: 10.1111/jocd.13420] [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: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pemphigus vegetans is an autoimmune bullous disorder characterized by vegetating lesions commonly over the flexures. This disorder is characterized by vegetating lesions more commonly over flexures. Cerebriform tongue, a morphology with typical pattern of sulci and gyri over dorsum of the tongue, is a well-known sign seen in pemphigus vegetans. AIMS To emphasize the exceptional but successful use of corticosteroid and 640 nm high-fluence visible red light in pemphigus vegetans. METHODS The patient was successfully treated with low dose systemic corticosteroid (methylprednisolone 20 mg daily) and high-fluence 640 nm LED red light on pustules and exudates (LIFOTRONICR, 120 mw/cm2 power density and 210 J/cm2 energy density). RESULTS The cerebriform plaques improved quickly after the treatment of corticosteroid and 640 nm high-fluence visible red light. CONCLUSION We propose to consider low dosage of methylprednisolone and 640 nm high fluence visible red light as first-line monotherapy in pemphigus vegetans, especially in elderly patients with comorbidities and contraindications to standard therapy, as it avoids the toxicities of systemic corticosteroids and immunosuppressants.
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Affiliation(s)
- Jing Wang
- Departments of Dermatology, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Xiaoyue Wang
- The College of Biological Science, University of California, Davis, Davis, CA, USA
| | - Yue Chen
- Departments of Dermatology, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Shuguang Liu
- Departments of Pathology, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Pengfei Song
- Departments of Dermatology, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
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Abstract
Pemphigus consists of a group of rare and severe autoimmune blistering diseases mediated by pathogenic autoantibodies mainly directed against two desmosomal adhesion proteins, desmoglein (Dsg)1 and Dsg3 (also known as DG1 and DG3), which are present in the skin and surface-close mucosae. The binding of autoantibodies to Dsg proteins induces a separation of neighbouring keratinocytes, in a process known as acantholysis. The two main pemphigus variants are pemphigus vulgaris, which often originates with painful oral erosions, and pemphigus foliaceus, which is characterised by exclusive skin lesions. Pemphigus is diagnosed on the basis of either IgG or complement component 3 deposits (or both) at the keratinocyte cell membrane, detected by direct immunofluorescence microscopy of a perilesional biopsy, with serum anti-Dsg1 or anti-Dsg3 antibodies (or both) detected by ELISA. Corticosteroids are the therapeutic mainstay, which have recently been complemented by the anti-CD20 antibody rituximab in moderate and severe disease. Rituximab induces complete remission off therapy in 90% of patients, despite rapid tapering of corticosteroids, thus allowing for a major corticosteroid-sparing effect and a halved number of adverse events related to corticosteroids.
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Affiliation(s)
- Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute for Experimental Dermatology, University of Lübeck, Lübeck, Germany.
| | - Michael Kasperkiewicz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France; INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandy University, Rouen, France
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21
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Karamova AE, Chikin VV, Znamenskaya LF, Nefedova MA, Mamedova ES. Pemphigus vegetans: A clinical case. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-2-55-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - L. F. Znamenskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - E. S. Mamedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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22
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Didona D, Maglie R, Eming R, Hertl M. Pemphigus: Current and Future Therapeutic Strategies. Front Immunol 2019; 10:1418. [PMID: 31293582 PMCID: PMC6603181 DOI: 10.3389/fimmu.2019.01418] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Pemphigus encompasses a heterogeneous group of autoimmune blistering diseases, which affect both mucous membranes and the skin. The disease usually runs a chronic-relapsing course, with a potentially devastating impact on the patients' quality of life. Pemphigus pathogenesis is related to IgG autoantibodies targeting various adhesion molecules in the epidermis, including desmoglein (Dsg) 1 and 3, major components of desmosomes. The pathogenic relevance of such autoantibodies has been largely demonstrated experimentally. IgG autoantibody binding to Dsg results in loss of epidermal keratinocyte adhesion, a phenomenon referred to as acantholysis. This in turn causes intra-epidermal blistering and the clinical appearance of flaccid blisters and erosions at involved sites. Since the advent of glucocorticoids, the overall prognosis of pemphigus has largely improved. However, mortality persists elevated, since long-term use of high dose corticosteroids and adjuvant steroid-sparing immunosuppressants portend a high risk of serious adverse events, especially infections. Recently, rituximab, a chimeric anti CD20 monoclonal antibody which induces B-cell depletion, has been shown to improve patients' survival, as early rituximab use results in higher disease remission rates, long term clinical response and faster prednisone tapering compared to conventional immunosuppressive therapies, leading to its approval as a first line therapy in pemphigus. Other anti B-cell therapies targeting B-cell receptor or downstream molecules are currently tried in clinical studies. More intriguingly, a preliminary study in a preclinical mouse model of pemphigus has shown promise regarding future therapeutic application of Chimeric Autoantibody Receptor T-cells engineered using Dsg domains to selectively target autoreactive B-cells. Conversely, previous studies from our group have demonstrated that B-cell depletion in pemphigus resulted in secondary impairment of T-cell function; this may account for the observed long-term remission following B-cell recovery in rituximab treated patients. Likewise, our data support the critical role of Dsg-specific T-cell clones in orchestrating the inflammatory response and B-cell activation in pemphigus. Monitoring autoreactive T-cells in patients may indeed provide further information on the role of these cells, and would be the starting point for designating therapies aimed at restoring the lost immune tolerance against Dsg. The present review focuses on current advances, unmet challenges and future perspectives of pemphigus management.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany.,Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.,Section of Dermatology, Departement of Health Sciences, University of Florence, Florence, Italy
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
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23
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Barbach Y, Baybay H, Mrabat S, Chaouche M, Elloudi S, Mernissi FZ. [Unexpected positive outcome following rituximab treatment in a patient with pemphigus vegetans resistant to conventional therapies: a case report]. Pan Afr Med J 2019; 32:101. [PMID: 31223391 PMCID: PMC6560954 DOI: 10.11604/pamj.2019.32.101.16743] [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: 08/04/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
Abstract
Le pemphigus végétant est une variété rare de pemphigus. Il n'y représente que 2%. Plusieurs traitements sont de mise pour traiter cette entité, on retrouve les corticostéroïdes topiques et/ou oraux en 1ère intension, les immunosuppresseurs tels que l'Azathioprine, la Cyclosporine, le Méthotrexate, le Cyclophosphamide et le Mycophénolate mofétil pour remédier au effet secondaires des stéroides. Certains cas restent réfractaires à tous ces traitements, l'utilisation du Rituximab a fait révolutionner la prise en charge du pemphigus, en particulier sa forme végétante. Nous rapportons le cas d'une patiente de 42ans, admise pour prise en charge d'un pemphigus végétant confirmé histologiquement et mise initialement sous corticothérapie en association avec immunosuppresseur sans amélioration, puis fut mise sous Rituximab avec une évolution spectaculaire.
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Affiliation(s)
| | | | - Samia Mrabat
- Service de Dermatologie, CHU Hassan II, Fès, Maroc
| | | | - Sara Elloudi
- Service de Dermatologie, CHU Hassan II, Fès, Maroc
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24
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Basu K, Chatterjee M, De A, Sengupta M, Datta C, Mitra P. A Clinicopathological and Immunofluorescence Study of Intraepidermal Immunobullous Diseases. Indian J Dermatol 2019; 64:101-105. [PMID: 30983604 PMCID: PMC6440185 DOI: 10.4103/ijd.ijd_515_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: Autoimmune blistering diseases (AIBDs) are characterized by autoantibodies directed against antigens of skin. Direct immunofluorescence (DIF) study helps in confirming the diagnosis where histopathology alone is noncontributory. Aims: This study aimed to evaluate the clinicopathological and DIF features of intraepidermal AIBD and to assess their relative diagnostic significance. Materials and Methods: It was an institution-based observational study. A total of 34 patients were studied over a period of 1½ years in the Department of Pathology in collaboration with the Department of Dermatology of a tertiary care hospital. The clinical, pathological, and DIF features were evaluated and documented. Statistical Analysis: Data were analyzed by statistical tests using GraphPad InStat. Results: Pemphigus vulgaris (PV) was the predominant type with 18 (53%) cases followed by 15 (44%) cases of pemphigus foliaceus (PF) and a single case of pemphigus erythematosus (PE). The age of the patients ranged from 17 to 85 years. Overall, there was a female preponderance in the study group. The most common presenting feature was pruritus (58.82%). Tzanck smear showed the presence of acantholytic cells in thirty (88.24%) patients. Characteristic histopathological features were present in all the cases of PV and PF except one case of PF which was found to be a case of PE. DIF study showed intraepidermal deposition of intercellular immunoglobulin G (IgG) and C3 both in PV and PF. The case of PE showed epidermal “antinuclear antibody” staining with IgG. Conclusion: Immunofluorescence study may be used as an additional tool for confirmation of diagnosis where histopathology alone is inconclusive.
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Affiliation(s)
- Keya Basu
- Departments of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Moumita Chatterjee
- Departments of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Moumita Sengupta
- Departments of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Chhanda Datta
- Departments of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pradip Mitra
- Departments of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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25
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Carey B, Joshi S, Semkova K, Setterfield J. A painful vegetating finger. Clin Exp Dermatol 2018; 44:549-552. [PMID: 30264461 DOI: 10.1111/ced.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- B Carey
- Department of Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Joshi
- Department of Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Semkova
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - J Setterfield
- Department of Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Mucosal and Salivary Biology Division, Dental Institute, King's College London, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Zaouak A, Jouini R, Ben Brahim E, Hammami H, Fenniche S. Multiple vegetating plaques on a Cesarean section scar. Int J Dermatol 2018; 58:47-49. [PMID: 29799124 DOI: 10.1111/ijd.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anissa Zaouak
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Raja Jouini
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Ehsen Ben Brahim
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Houda Hammami
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Samy Fenniche
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia
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27
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Nelson CA, Elder DE, Elenitsas R, Weir M. Conjunctivitis, mucosal erosions, and moist cutaneous plaques. JAAD Case Rep 2018; 4:117-119. [PMID: 29349113 PMCID: PMC5767905 DOI: 10.1016/j.jdcr.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Weir
- Department of Medicine, Section of Dermatology, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois
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28
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Yamaguchi Y, Shinkuma S, Ishii N, Takashima S, Natsuga K, Ujiie H, Iwata H, Nomura T, Fujita Y, Hamasaka A, Hamasaka K, Hashimoto T, Shimizu H. Appearance of antidesmocollin 1 autoantibodies leading to a vegetative lesion in a patient with pemphigus vulgaris. Br J Dermatol 2017; 178:294-295. [DOI: 10.1111/bjd.15834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Yamaguchi
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - S. Shinkuma
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - N. Ishii
- Department of Dermatology Kurume University School of Medicine Kurume Fukuoka Japan
- Kurume University Institute of Cutaneous Cell Biology Kurume Fukuoka Japan
| | - S. Takashima
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - K. Natsuga
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - H. Ujiie
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - H. Iwata
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - T. Nomura
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - Y. Fujita
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | | | | | - T. Hashimoto
- Department of Dermatology Kurume University School of Medicine Kurume Fukuoka Japan
- Kurume University Institute of Cutaneous Cell Biology Kurume Fukuoka Japan
| | - H. Shimizu
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
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29
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Çetinarslan TS, Ermertcan AT, Temiz P, Kurutepe S. Pemphigus vegetans arising in umbilicus: Successful clearance with intralesional steroid. Indian J Dermatol Venereol Leprol 2017; 84:522. [PMID: 28879869 DOI: 10.4103/ijdvl.ijdvl_559_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Aylin Türel Ermertcan
- Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Department of Pathology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Semra Kurutepe
- Department of Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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30
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Mergler R, Kerstan A, Schmidt E, Goebeler M, Benoit S. Atypical Clinical and Serological Manifestation of Pemphigus Vegetans: A Case Report and Review of the Literature. Case Rep Dermatol 2017; 9:121-130. [PMID: 28559810 PMCID: PMC5437479 DOI: 10.1159/000468919] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022] Open
Abstract
Pemphigus vegetans (PVeg) is a rare variant of pemphigus vulgaris characterized by pustules and/or papillomatous vegetations, preferentially affecting intertriginous and periorificial areas. Exceptional manifestations may be misdiagnosed resulting in delayed diagnosis and treatment. Diagnosis is confirmed by immunofluorescence and detection of anti-desmoglein (Dsg) 3 and/or anti-Dsg1 antibodies. We herein report an unusual manifestation of PVeg. At the time of first presentation, lesions were restricted to the right ring finger's tip. Although mucous membranes were initially not affected, high levels of anti-Dsg3 antibodies were detected while anti-Dsg1 and anti-desmocollin (Dsc) 1, 2, and 3 antibodies were absent. To compare our immunological findings with previous reports, all accessible Anglophone literature published since December 1988 was evaluated. We identified 52 patients suffering from PVeg, 7 of these showed anti-Dsg3 antibodies without any mucous membrane involvement. Notably, the detection of anti-Dsg1 and anti-Dsg3 antibodies does not necessarily correlate with the involvement of skin and/or mucous membranes. This might be due to more specific and complex antibody constellations in nonclassical or atypical pemphigus.
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Affiliation(s)
- Rebecca Mergler
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Kerstan
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Enno Schmidt
- bDepartment of Dermatology, Venereology and Allergology, University of Lübeck, Lübeck, Germany
| | - Matthias Goebeler
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Sandrine Benoit
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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31
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Abstract
Proctology is a medical subspecialty that encompasses diseases of the perianal region, anal canal, and rectum. Dermatologists play a pivotal role in this realm, as inflammatory perianal disorders, infectious and sexually transmitted diseases, as well as perianal tumors and their precursor lesions fall within the core competency of dermatology. In a concise manner, the present article highlights all relevant disease groups in the field of proctology. With a particular focus on aspects pertinent to dermatologists, this includes inflammatory disorders, "classic" proctologic diseases, sexually transmitted diseases, malignancies of the anal region, as well as pathogen-induced diseases. Despite the wide variety of disorders, there are only five key symptoms prompting patients to consult a proctologist, including anal pruritus and burning, discharge, bleeding, pain, and foreign body sensation. A simple algorithm, which incorporates these symptoms as well as key clinical features, may assist in quickly establishing the correct diagnosis in everyday clinical practice.
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Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital, Oberhausen, Germany
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von Köckritz A, Ständer S, Zeidler C, Metze D, Luger T, Bonsmann G. Successful monotherapy of pemphigus vegetans with minocycline and nicotinamide. J Eur Acad Dermatol Venereol 2016; 31:85-88. [DOI: 10.1111/jdv.13779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. von Köckritz
- Department of Dermatology; University of Muenster; Muenster Germany
| | - S. Ständer
- Department of Dermatology; University of Muenster; Muenster Germany
| | - C. Zeidler
- Department of Dermatology; University of Muenster; Muenster Germany
| | - D. Metze
- Department of Dermatology; University of Muenster; Muenster Germany
| | - T. Luger
- Department of Dermatology; University of Muenster; Muenster Germany
| | - G. Bonsmann
- Department of Dermatology; University of Muenster; Muenster Germany
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Kreuter A. Proktologie - Erkrankungen der Analregion. J Dtsch Dermatol Ges 2016. [DOI: 10.1111/ddg.12986_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie; HELIOS St. Elisabeth Klinik; Oberhausen
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Vinay K, De D, Handa S, Saikia UN, Minz RW. Pemphigus vegetans presenting as a verrucous plaque on the finger. Clin Exp Dermatol 2015. [PMID: 26204944 DOI: 10.1111/ced.12739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - D De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - S Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - U N Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - R W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Marchalik R, Reserva J, Plummer MA, Braniecki M. Pemphigus vegetans with coexistent herpes simplex infection and deep venous thrombosis of the lower extremities. BMJ Case Rep 2015; 2015:bcr-2015-210143. [PMID: 26178000 DOI: 10.1136/bcr-2015-210143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An elderly patient presented with a 4-month history of eroded hypertrophic condylomatous plaques with areas of vesiculation on the groin and lower extremities bilaterally, associated with swelling. Biopsy and immunofluorescence studies confirmed the diagnosis of pemphigus vegetans (PVeg). Further clinical evaluation revealed deep venous thrombosis of the lower extremities and septic shock from secondarily infected pemphigus lesions. Fluid obtained from vesicles was positive for herpes simplex virus (HSV) via PCR-based testing. The patient was therapeutically anticoagulated, treated with high-dose corticosteroid therapy, broad-spectrum intravenous antibiotics and acyclovir. This case represents a constellation of diagnoses not previously described. Although pemphigus vulgaris has been linked to thromboembolic events and has been associated with HSV, these associations have not been previously reported in PVeg. The coexistence of these diseases should encourage vigilance in the clinical work up of a patient with PVeg.
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Affiliation(s)
| | - Jeave Reserva
- Division of Dermatology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Malgorzata Anna Plummer
- Department of Surgery/Division of Vascular Surgery, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Chicago, Illinois, USA
| | - Marylee Braniecki
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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Abstract
Eosinophil infiltration can be observed in skin disorders, such as allergic/immunologic, autoimmune, infectious, and neoplastic diseases. Clinical presentations are variable and include eczematous, papular, urticarial, bullous, nodular, and fibrotic lesions; pruritus is a common symptom in all. In this review, we present representative eosinophilic skin diseases according to their clinical pattern, together with histologic findings and diagnostic procedures. We also discuss the potential roles of eosinophils in the pathogenesis of dermatologic disorder. Current pathogenesis-based diagnostic and therapeutic approaches are outlined.
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Affiliation(s)
- Elisabeth de Graauw
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland; Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland.
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Caetano LDVN, Enokihara MMSES, Porro AM. Recurrent angular cheilitis in a patient with mucocutaneous pemphigus vulgaris. Clin Exp Dermatol 2015; 40:819-21. [PMID: 25788140 DOI: 10.1111/ced.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - A M Porro
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
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Mori M, Mariotti G, Grandi V, Gunnella S, Maio V. "Pemphigus vegetans of the scalp". J Eur Acad Dermatol Venereol 2014; 30:368-70. [PMID: 25339136 DOI: 10.1111/jdv.12793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Mori
- Department of Surgery and Translational Medicine, Division of Dermatology and Venereology, University of Florence, Florence, Italy
| | - G Mariotti
- Department of Surgery and Translational Medicine, Division of Dermatology and Venereology, University of Florence, Florence, Italy
| | - V Grandi
- Department of Surgery and Translational Medicine, Division of Dermatology and Venereology, University of Florence, Florence, Italy
| | - S Gunnella
- Department of Surgery and Translational Medicine, Division of Dermatology and Venereology, University of Florence, Florence, Italy
| | - V Maio
- Division of Pathological Anatomy, University of Florence, Florence, Italy
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Lo CS, Kuo TT, Lin JW. A case of pemphigus vegetans occurring at an unusual site and followed by gastric cancer. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hatano Y, Ishikawa K, Koga H, Ishii N, Hashimoto T, Takeo N, Shimada H, Sakai T, Okamoto O, Fujiwara S. A case of concurrent pemphigoid vegetans and pemphigus vegetans resolving without oral corticosteroid. Br J Dermatol 2014; 170:1192-4. [DOI: 10.1111/bjd.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Hatano
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - K. Ishikawa
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - H. Koga
- Department of Dermatology; Kurume University School of Medicine; Kurume University Institute of Cutaneous Cell Biology; 67 Asahimachi Kurume Fukuoka 830-0011 Japan
| | - N. Ishii
- Department of Dermatology; Kurume University School of Medicine; Kurume University Institute of Cutaneous Cell Biology; 67 Asahimachi Kurume Fukuoka 830-0011 Japan
| | - T. Hashimoto
- Department of Dermatology; Kurume University School of Medicine; Kurume University Institute of Cutaneous Cell Biology; 67 Asahimachi Kurume Fukuoka 830-0011 Japan
| | - N. Takeo
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - H. Shimada
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - T. Sakai
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - O. Okamoto
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
| | - S. Fujiwara
- Department of Dermatology; Faculty of Medicine; Oita University; Hasama Yufu 879-5593 Japan
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Gupta SR, Batra V, Chaudhry Z, Sethi R. An unusual vesiculopustular and vegetative lesion on the lips. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 116:666-72. [PMID: 22901647 DOI: 10.1016/j.oooo.2012.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/02/2012] [Accepted: 04/17/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Shalini R Gupta
- Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India.
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