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Mortazavi H, Hazrati P, Koohi H, Sarrafan-Sadeghi T, Moradian-Lotfi S. Ocular involvement in oral vesiculobullous diseases: A review on reported cases in the literature. Saudi Dent J 2024; 36:546-560. [PMID: 38690390 PMCID: PMC11056430 DOI: 10.1016/j.sdentj.2023.12.012] [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: 09/02/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 05/02/2024] Open
Abstract
Introduction Vesiculobullous disorders are a group of autoimmune diseases manifesting as chronic ulcers in the oral cavity. Ocular involvement may accompany oral ulcers and cause various problems for patients. This review summarizes the data regarding ocular involvement in patients with oral vesiculobullous. Methods Web of Science, Scopus, PubMed/MEDLINE, and Embase electronic databases were searched according to related keywords. Finally, 58 articles were included, all of which were case reports or series. Characteristics such as the age and sex of patients, location and type of oral lesion, type of ophthalmic injury, the interval between oral and ocular lesion, and treatment of oral and ocular disorders were summarized in tables. Results Eye involvement was 1.6 times more prevalent in women, and most patients were between 30 and 60 years old (67.4 %). Pemphigus vulgaris accounted for almost half of the cases (48.4 %), though lichen planus is more prevalent in the general population. The most frequently affected oral site was the buccal mucosa (17.5 %), and oral ulcers usually presented as erythema, erosion, or inflammation (22.7 %). Conjunctivitis was the most common type of eye involvement (18.4 %), and ophthalmic lesions regularly appeared 12-60 months after the development of oral lesions (30.1 %). Blindness was reported in only one case. Corticosteroids and immunosuppressives were the most frequent oral and ocular lesion therapies. Conclusion Considering the serious burdens of any ocular injury, monitoring the ocular health of patients with oral vesiculobullous diseases is highly recommended in high-risk cases, especially middle-aged women with oral pemphigus vulgaris.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Hazrati
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hediye Koohi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shima Moradian-Lotfi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Miyahara H, Oya K, Kubota N, Ishii N, Nomura T. Pemphigoid without mucous involvement showing IgG antibodies to the β3 subunit of laminin-332. J Dtsch Dermatol Ges 2024; 22:570-573. [PMID: 38326082 DOI: 10.1111/ddg.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/01/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Hanako Miyahara
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazumasa Oya
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noriko Kubota
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Miyahara H, Oya K, Kubota N, Ishii N, Nomura T. Pemphigoid ohne Schleimhautbeteiligung, mit IgG‐Antikörpern gegen die β3‐Untereinheit von Laminin‐332. J Dtsch Dermatol Ges 2024; 22:570-573. [PMID: 38574035 DOI: 10.1111/ddg.15318_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/01/2023] [Indexed: 04/06/2024]
Affiliation(s)
- Hanako Miyahara
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazumasa Oya
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noriko Kubota
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Higgins TS, Cohen JC, Sinacori JT. Laryngeal mucous membrane pemphigoid: A systematic review and pooled-data analysis. Laryngoscope 2010; 120:529-36. [DOI: 10.1002/lary.20763] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rose C, Schmidt E, Kerstan A, Thoma-Uszynski S, Wesselmann U, Käsbohrer U, Zillikens D, Shimanovich I. Histopathology of anti-laminin 5 mucous membrane pemphigoid. J Am Acad Dermatol 2009; 61:433-40. [PMID: 19700013 DOI: 10.1016/j.jaad.2009.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 02/02/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anti-laminin 5 mucous membrane pemphigoid (MMP) is an autoimmune blistering disease characterized by autoantibodies against the major basement membrane component laminin 5 (laminin 332, epiligrin). OBJECTIVE AND METHODS We reviewed 17 biopsy specimens from 9 patients with anti-laminin 5 MMP in an attempt to define typical histopathologic features of the disease. RESULTS Fifteen specimens showed subepidermal blister formation, while two biopsy specimens revealed an epithelial ulcer. In 11 biopsies a sparse to moderate inflammatory infiltrate composed of lymphocytes and neutrophils with some eosinophils was observed. Four biopsies showed a dense infiltrate dominated by neutrophils in two cases and by eosinophils in one case. The remaining biopsy revealed a dense lymphoplasmacellular infiltrate without granulocytes. Scarring of the upper dermis was present only in 5 specimens. Immunohistochemical analysis localized type IV collagen to the dermal side of the blister, suggesting that split formation occurred within the lamina lucida of the cutaneous basement membrane. LIMITATIONS The number of patients studied was relatively small. CONCLUSIONS Histopathology of anti-laminin 5 MMP is characterized by subepidermal blistering and a sparse to moderate superficial lymphohistiocytic infiltrate with neutrophils and/or eosinophils. Both infiltrate density and composition may vary, making anti-laminin 5 MMP indistinguishable from other autoimmune subepidermal blistering diseases by histopathology alone. Scarring is present only in a minority of cases and is not a sensitive clue to the diagnosis of anti-laminin 5 MMP.
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Affiliation(s)
- Christian Rose
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Hartwig B, Borm B, Schneider H, Arin MJ, Kirfel G, Herzog V. Laminin-5-deficient human keratinocytes: defective adhesion results in a saltatory and inefficient mode of migration. Exp Cell Res 2007; 313:1575-87. [PMID: 17335805 DOI: 10.1016/j.yexcr.2007.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 01/30/2007] [Accepted: 02/03/2007] [Indexed: 01/13/2023]
Abstract
Laminin-5 is a major adhesion protein of the skin basement membrane and crucially involved in integrin-mediated cell substrate attachment of keratinocytes, which is important for hemidesmosomal anchorage as well as for keratinocyte migration during epidermal wound healing. To investigate its role in keratinocyte migration, we analyzed laminin-5-deficient cells of patients with a lethal variant of junctional epidermolysis bullosa. Normal migrating keratinocytes adopted monopolar morphology with a distinct front lamella and employed a continuous mode of translocation. In contrast, laminin-5-deficient cells assumed a stretched bipolar shape with two lamella regions and migrated in a discontinuous, saltatory manner characterized by significantly decreased directional persistence and reduced migration velocity. The distinct morphology as well as the migratory phenotype apparently resulted from a defect in the formation of cell substrate adhesions that were completely missing in the cell body and less stable in the lamella regions. Accordingly in normal keratinocytes, a bipolar shape and a saltatory migration mode were inducible by blocking laminin-5-mediated substrate adhesion. Our findings clearly point to an essential role of laminin-5 in forming dynamic cell substrate adhesion during migration of epidermal keratinocytes and provide an explanation for the cellular mechanisms that underlie the lethal form of junctional epidermolysis bullosa.
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Affiliation(s)
- Benedikt Hartwig
- Institut für Zellbiologie, Universität Bonn, Ulrich-Haberlandstrasse 61a, D-53121 Bonn, Germany
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Coronella G, Amato L, Berti S, Moretti S, Terracina M, Mastrogiacomo A, Fabbri P. Ocular 'non-scarring' mucous membrane pemphigoid associated with anti-laminin-5 antibodies. Clin Exp Dermatol 2005; 30:679-81. [PMID: 16197388 DOI: 10.1111/j.1365-2230.2005.01923.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mucous membrane pemphigoid is a rare, chronic autoimmune disease characterized by subepidermal blistering and scarring, predominantly affecting mucous membranes. Ocular involvement frequently occurs and often represents the only manifestation of the disease. We describe a 62-year-old woman with a bilateral 18-month duration of conjunctival hyperaemia, associated with erythema and oedema of the eyelids, lacking any typical ocular signs of mucous membrane pemphigoid such as sub-conjuctival fibrosis and scarring. Histology was not significant. Direct immunofluorescence of the conjunctiva showed IgG, IgA and complement deposition along the basement membrane zone. Immunoprecipitation analysis of affinity purified laminin-5 revealed a band consistent with the beta3 chain of laminin-5. This represents the first case of pure ocular mucous membrane pemphigoid associated with anti-laminin-5 antibodies.
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Affiliation(s)
- G Coronella
- Department of Dermatological Sciences, University of Florence, Florence, Italy
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Abstract
Mucous membrane pemphigoid (MMP) is a sub-epithelial vesiculobullous disorder. It is now quite evident that a number of sub-epithelial vesiculobullous disorders may produce similar clinical pictures, and also that a range of variants of MMP exist, with antibodies directed against various hemidesmosomal components or components of the epithelial basement membrane. The term immune-mediated sub-epithelial blistering diseases (IMSEBD) has therefore been used. Immunological differences may account for the significant differences in their clinical presentation and responses to therapy, but unfortunately data on this are few. The diagnosis and management of IMSEBD on clinical grounds alone is impossible and a full history, general, and oral examination, and biopsy with immunostaining are now invariably required, sometimes supplemented with other investigations. No single treatment regimen reliably controls all these disorders, and it is not known if the specific subsets of MMP will respond to different drugs. Currently, apart from improving oral hygiene, immunomodulatory-especially immunosuppressive-therapy is typically used to control oral lesions. The present paper reviews pemphigoid, describing the present understanding of this fascinating clinical phenotype, summarising the increasing number of subsets with sometimes-different natural histories and immunological features, and outlining current clinical practice.
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Affiliation(s)
- J Bagan
- University of Valencia, Spain
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Uchino Y, Kanekura T, Takeda K, Shimada H, Inoue M, Hashimoto T, Kanzaki T. A case of antiepiligrin cicatricial pemphigoid with nephrotic syndrome. J Dermatol 2004; 31:228-31. [PMID: 15187343 DOI: 10.1111/j.1346-8138.2004.tb00660.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Accepted: 12/02/2003] [Indexed: 11/27/2022]
Abstract
We report a 71-year-old woman with antiepiligrin cicatricial pemphigoid associated with nephrotic syndrome. She presented with a six-month history of pruritic blisters over her trunk and legs. She also had episodes of recurrent painful oral erosions. A skin biopsy showed a subepidermal bulla, and a direct immunofluorescence (DIF) study revealed linear deposition of IgG and C3 at the basement membrane zone (BMZ). Indirect immunofluorescence (IIF) staining of 1 M NaCl-split skin demonstrated circulating IgG autoantibodies reactive with the dermal side. Immunoprecipitation studies of the patient's serum disclosed IgG autoantibodies directed against a set of polypeptides that corresponded to laminin 5 (beta 3 gamma 2). Based upon the long-standing edema of her legs and her hypoproteinemia, she was diagnosed with nephrotic syndrome. To our knowledge, the association of antiepiligrin cicatricial pemphigoid with nephrotic syndrome has not been reported previously.
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Affiliation(s)
- Yuri Uchino
- Department of Dermatology, Kagoshima University Faculty of Medicine, Kagoshima, Japan
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Olivry T, Dunston SM, Zhang G, Ghohestani RF. Laminin-5 is targeted by autoantibodies in feline mucous membrane (cicatricial) pemphigoid. Vet Immunol Immunopathol 2002; 88:123-9. [PMID: 12127411 DOI: 10.1016/s0165-2427(02)00166-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In human and canine patients with mucous membrane (cicatricial) pemphigoid (MMP), circulating autoantibodies have been shown to target multiple epidermal basement membrane antigenic epitopes. These autoantigens include collagen XVII in humans and dogs, as well as laminin-5, laminin-6 or integrin alpha-6/beta-4 in human beings. The purpose of this study was to determine if autoantibodies targeted laminin-5 in a cat exhibiting clinical and microscopic lesions resembling those of MMP in humans. In this patient, an indirect immunofluorescence (IF) assay revealed circulating IgG and IgA autoantibodies that bound to the basement membrane zone on the dermal side of salt-split gingiva (titer 1:1000 for IgG and 1:50 for IgA). Immunoblotting, performed with affinity-purified human laminin-5, demonstrated that the autoantibodies bound the alpha-3 chain of this heterotrimer. These observations identify laminin-5 as one of the antigens recognized by circulating autoantibodies in this feline homologue of MMP in humans and dogs.
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Affiliation(s)
- Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC, USA.
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Ly A, Roth B, Causeret AS, Jullien D, Kanitakis J, Faure M, Claudy A. Anti-laminin 5 pemphigoid and acquired haemophilia. Br J Dermatol 2002; 146:1104-5. [PMID: 12072091 DOI: 10.1046/j.1365-2133.2002.47323.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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