1
|
España A, Fernandez S. Exploring beyond the oral mucosa in patients affected with autoimmune blistering diseases: the importance of endoscopic procedures. J Eur Acad Dermatol Venereol 2016; 31:791-797. [PMID: 27624852 DOI: 10.1111/jdv.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Collapse
Affiliation(s)
- A España
- Department of Dermatology, School of Medicine, University Clinic of Navarra, Navarra, Spain.,Unit of Autoimmune Blistering Skin Disorders, School of Medicine, University Clinic of Navarra, Navarra, Spain
| | - S Fernandez
- Department of Otorhinolaryngology, School of Medicine, University Clinic of Navarra, Navarra, Spain.,Unit of Autoimmune Blistering Skin Disorders, School of Medicine, University Clinic of Navarra, Navarra, Spain
| |
Collapse
|
2
|
Pascoe VL, Fenves AZ, Wofford J, Jackson JM, Menter A, Kimball AB. The spectrum of nephrocutaneous diseases and associations. J Am Acad Dermatol 2016; 74:247-70; quiz 271-2. [DOI: 10.1016/j.jaad.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/31/2022]
|
3
|
Fawzy MM, Hegazy RA, Abdel Fattah AF. Ear, nose, and throat involvement in Egyptian patients with pemphigus vulgaris: a step towards a better management. Int J Dermatol 2013; 52:1268-73. [PMID: 23829869 DOI: 10.1111/j.1365-4632.2012.05846.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The frequency of ear, nose, and throat (ENT) involvement in pemphigus vulgaris (PV) is not clear; thereby, the importance of setting routine ENT examination for patients with PV could not be deduced. OBJECTIVE Determine the prevalence of ENT involvement in patients with PV in Egypt; to modify the routine protocol and achieve a step towards better management. PATIENTS AND METHODS Thirty-four patients with PV were included. Patients were asked about ENT symptomatology and evaluated for ENT manifestations. RESULTS Twenty-five patients complained from ENT symptoms (74%). The pharyngeal/laryngeal-related symptoms were the most common. Eighty-two percent of patients had positive endoscopic findings. The most common were pharyngeal/laryngeal (76.5%). In total, the positive endoscopic findings superseded the positive symptomatic findings. More severe involvement was documented in non-smoking patients (P < 0.05). CONCLUSION Full ENT examination as a routine for all patients with PV could be of great value, as it would lead to more accurate diagnosis, therefore improved management.
Collapse
Affiliation(s)
- Marwa Mohamed Fawzy
- Departments of Dermatology and Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | |
Collapse
|
4
|
Robati RM, Rahmati-Roodsari M, Dabir-Moghaddam P, Farnaghi A, Mahboobi-rad F, Rahimi H, Toossi P. Mucosal manifestations of pemphigus vulgaris in ear, nose, and throat; before and after treatment. J Am Acad Dermatol 2011; 67:e249-52. [PMID: 22015151 DOI: 10.1016/j.jaad.2011.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/14/2011] [Accepted: 06/16/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disease, mediated by autoantibodies directed against antigens on the keratinocyte cell surface of stratified squamous epithelia. The frequency of ear, nose, and throat (ENT) involvement in PV is not clearly identified. OBJECTIVE We sought to evaluate the ENT involvement in new patients with PV examined by ENT endoscopy before and after treatment. METHODS This study included 41 new patients with PV. All patients were evaluated for ENT manifestations by otoscopic and endoscopic examination before treatment. After these examinations, the patients received proper treatment according to standard protocols. Thirty patients were re-evaluated by endoscopic examination after clinical remission of mucocutaneous signs. RESULTS A total of 41 (33 [80.5%] male and 8 [19.5%] female) patients with mean age of 44.56 ± 12.76 years entered this study. In ENT examination of patients before the treatment, 11 (26.8%) patients showed ear, 15 (36.6%) nasal, 37 (90.3%) oral, 25 (61%) pharyngeal, and 24 (58.5%) laryngeal involvement. Thirty patients underwent the posttreatment ENT examination. We found ear signs in 2 (6.7%), nasal involvement in 1 (3.3%), oral signs in 4 (13.3%), pharyngeal manifestations in 6 (20%), and laryngeal signs in 3 (10%) patients after treatment. The treatment was significantly effective in the improvement of mucosal lesion in different sites (P < .01). LIMITATION Eleven patients refused to undergo posttreatment ENT examination. CONCLUSION ENT evaluation may be worthwhile to evaluate the disease extension in patients with PV more definitely and exclude other potential etiologies in recalcitrant patients.
Collapse
Affiliation(s)
- Reza Mahmoud Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran.
| | | | | | | | | | | | | |
Collapse
|
5
|
Kavala M, Altıntaş S, Kocatürk E, Zindancı I, Can B, Ruhi C, Turkoglu Z. Ear, nose and throat involvement in patients with pemphigus vulgaris: correlation with severity, phenotype and disease activity. J Eur Acad Dermatol Venereol 2011; 25:1324-7. [PMID: 21348898 DOI: 10.1111/j.1468-3083.2011.03981.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is the most common clinical form of pemphigus that is characterized by easily ruptured or loose bulla formation on skin and/or mucosa. The frequency of the ear, nose and throat involvement of PV is not clearly defined. OBJECTIVES To evaluate the frequency of ear, nose and throat (ENT) involvement in patients suffering from PV who had been recently diagnosed or exacerbated under follow up and to determine the association with ENT symptoms, clinical involvement, severity and duration of pemphigus vulgaris. MATERIALS AND METHODS The study group included a total of 38 PV patients comprising 24 new patients and 14 patients who showed exacerbations while on complete remission or under treatment. All patients were asked about ENT symptoms and endoscopic examination were performed to evaluate the presence of nasal, pharynx, larynx and ear involvement. RESULTS Of the 38 patients, 33 (87%) had active PV lesions on endoscopic evaluation. Twenty-five patients (66%) had lesions on pharynx, twenty-one (55%) on larynx, twenty-nine (76%) on nasal mucosa and four (10%) on the ear mucosa. ENT involvement was not associated with the severity and the clinical involvement of the disease. Pharyngeal and nasal involvement was significantly associated with symptoms, while laryngeal and ear involvement was not found to be significantly associated with symptoms. Nasal and ear involvement was not associated with the duration of the disease while pharyngeal and laryngeal involvement favored newly diagnosed patients. CONCLUSIONS Our results revealed that high number of patients with PV may present with active ENT lesions, furthermore patients with ear, nose and throat involvement may be asymptomatic and active lesions may be found in patients without any ENT symptoms. Therefore it should be considered that to understand the real extent of PV involvement, endoscopic ENT evaluation should be performed in patients with or without symptoms.
Collapse
Affiliation(s)
- M Kavala
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
6
|
Pemphigus vulgaris of the larynx and upper gastro-intestinal tract induced by radiotherapy. Acta Oncol 2009; 47:324-6. [PMID: 17957503 DOI: 10.1080/02841860701558831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
España A, Fernández S, del Olmo J, Marquina M, Pretel M, Ruba D, Sánchez-Ibarrola A. Ear, nose and throat manifestations in pemphigus vulgaris. Br J Dermatol 2007; 156:733-7. [PMID: 17493073 DOI: 10.1111/j.1365-2133.2007.07783.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are two clinical forms: mucosal (MPV) and mucocutaneous (MCPV). The frequency of ear, nose and throat (ENT) involvement in PV is not clearly defined. Only a few isolated individual cases have been reported. OBJECTIVES The objective of our study was to determine the incidence of ENT involvement in patients with PV. PATIENTS We studied prospectively all 16 patients diagnosed with PV and treated in the Department of Dermatology of the University Clinic of Navarra between 2001 and 2005. They were 10 cases of MPV and six cases of MCPV. All patients were evaluated for ENT manifestations by endoscopic examination. RESULTS Of the 16 patients, 13 presented with throat symptoms (81%), 12 pharyngeal (75%) and seven laryngeal symptoms (44%). Fourteen patients (88%) had active PV lesions on endoscopic evaluation (eight patients had active lesions on both pharyngeal and laryngeal mucosa, four had PV lesions only on laryngeal mucosa and two had PV lesions on pharyngeal mucosa). Laryngeal lesions were most commonly present in MPV patients. The frequency of nasal symptoms (38%) was lower than active PV lesions (62%) found on ENT examination. Oral symptoms and oral active PV lesions were the most frequent findings (94%). Only three patients with MCPV showed erosions on the external auditory canal. CONCLUSIONS As ENT endoscopy allows more extensive areas of mucosa to be examined than simple visual inspection, we recommend that it be included in the examination of all patients with PV. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved.
Collapse
Affiliation(s)
- A España
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, 31080 Pamplona, Navarra, Spain.
| | | | | | | | | | | | | |
Collapse
|
8
|
Dańczak-Pazdrowska A, Pazdrowski J, Bowszyc-Dmochowska M, Dmochowski M. Zmiany w krtani w pęcherzycy zwykłej z dominacją zmian na błonach śluzowych. Otolaryngol Pol 2007; 61:509-12. [DOI: 10.1016/s0030-6657(07)70472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
9
|
Vasiliou A, Nikolopoulos TP, Manolopoulos L, Yiotakis J. Laryngeal pemphigus without skin manifestations and review of the literature. Eur Arch Otorhinolaryngol 2006; 264:509-12. [PMID: 17111102 DOI: 10.1007/s00405-006-0208-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 10/15/2006] [Indexed: 11/24/2022]
Abstract
Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.
Collapse
Affiliation(s)
- A Vasiliou
- Department of Otorhinolaryngology, Athens University, Ippokration Hospital, Athens, Greece
| | | | | | | |
Collapse
|
10
|
Tabuchi K, Nomura M, Murashita H, Fujisawa Y, Tsuji S, Okubo H, Hara A. Coexistence of pemphigus vulgaris and bullous pemphigoid in the upper aerodigestive tract. Auris Nasus Larynx 2006; 33:231-3. [PMID: 16168587 DOI: 10.1016/j.anl.2005.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
Pemphigus vulgaris and bullous pemphigoid are autoimmune blistering diseases of the skin and the mucosa characterized by circulating autoantibodies. Coexistence of these lesions is extremely uncommon. We report herein a case of both pemphigus vulgaris and bullous pemphigoid which occurred in the upper aerodigestive tract. The diagnosis was made based on the circulating autoantibodies and direct immunofluorescent studies. The literature on this subject is reviewed.
Collapse
Affiliation(s)
- Keiji Tabuchi
- Department of Otolaryngology, Doctorial Program in Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
| | | | | | | | | | | | | |
Collapse
|
11
|
Frishman WH, Brosnan BD, Grossman M, Dasgupta D, Sun DK. Adverse dermatologic effects of cardiovascular drug therapy: part II. Cardiol Rev 2002; 10:285-300. [PMID: 12215192 DOI: 10.1097/00045415-200209000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with class III, IV, and other antiarrhythmic agents, ACE inhibitors, Angiotensin II receptor blockers, and diuretics.
Collapse
Affiliation(s)
- William H Frishman
- Departments of Medicine and Dermatology, New York Medical College, Valhalla, New York 10605, USA
| | | | | | | | | |
Collapse
|
12
|
Palleschi GM, Cipollini EM, Lotti T. Development of oesophageal involvement in a subject with pemphigus vulgaris: a case report and review of the literature. J Eur Acad Dermatol Venereol 2002; 16:405-8. [PMID: 12224704 DOI: 10.1046/j.1468-3083.2002.00460.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case of a 50-year-old-man with pemphigus vulgaris involving the oropharyngolaryngeal mucosa and oesophagus. Oesophageal involvement of pemphigus vulgaris is relatively uncommon, especially in subjects in clinical remission, and has been rarely described in the literature. Endoscopic examination should be performed to avoid inappropriate therapy due to misdiagnosis of steroid-induced oesophagitis and peptic ulcers.
Collapse
Affiliation(s)
- G M Palleschi
- Department of Dermatology, University of Florence, Italy.
| | | | | |
Collapse
|
13
|
|