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van Beek N, Weidinger A, Schneider SW, Kleinheinz A, Gläser R, Holtsche MM, von Georg A, Hammers CM, Hübner F, Lima AL, Gola D, Sadik CD, Zillikens D, Katalinic A, Schmidt E, König IR. Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases. J Eur Acad Dermatol Venereol 2021; 35:1197-1202. [PMID: 33428263 DOI: 10.1111/jdv.17107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. OBJECTIVES To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). METHODS Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. RESULTS Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. CONCLUSIONS This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.
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Affiliation(s)
- N van Beek
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A Weidinger
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S W Schneider
- Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbe Medical Center, Buxtehude, Germany
| | - R Gläser
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M M Holtsche
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A von Georg
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - C M Hammers
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - F Hübner
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A-L Lima
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - D Gola
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - C D Sadik
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - A Katalinic
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
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Hübner F, König IR, Holtsche MM, Zillikens D, Linder R, Schmidt E. Prevalence and age distribution of pemphigus and pemphigoid diseases among paediatric patients in Germany. J Eur Acad Dermatol Venereol 2020; 34:2600-2605. [PMID: 32289873 DOI: 10.1111/jdv.16467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Autoimmune bullous diseases are rare and mostly occur in adults. Several cases and small case series have been described in children, but no systematic study about the prevalence of autoimmune bullous diseases (AIBD) in children is available. PATIENTS AND METHODS We analysed data of 1.7 million children insured in the largest German health insurance company based on the ICD-10-GM classification for the year 2015. Data were adjusted to the general German population based on the data of the Federal Statistical Office for the year 2015. RESULTS The prevalence of AIBD was calculated to 101.1/million children in 2015, resulting in about 1351 patients below the age of 18 years in Germany. The highest prevalence of all AIBD was seen for pemphigus vulgaris (30.5/million children) followed by linear IgA disease (24.5/million children) and bullous pemphigoid (4.9/million children). CONCLUSION Autoimmune bullous diseases in minors are scarce but should be taken into consideration in patients with pruritus and/or blisters and erosions on the skin and/or mucous membranes. Treatment is challenging, and due to the rarity of AIBD in minors, the management of these disorders in this patient population is best performed in specialized centres in a multidisciplinary approach, including paediatric dermatologists or dermatologists and paediatricians.
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Affiliation(s)
- F Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - M M Holtsche
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - R Linder
- Techniker Krankenkasse, Analytics & Insights, Hamburg, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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Holtsche MM, Zillikens D, Sadik CD. Diagnostik und Therapie des Anti-p200-Pemphigoids. Akt Dermatol 2020. [DOI: 10.1055/a-1015-4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungPemphigoid-Erkrankungen sind eine Gruppe von 7 Autoimmunerkrankungen, bei denen es durch Bildung von Autoantikörpern gegen Proteine des dermal-epidermalen Adhäsionskomplexes zu einer Entzündung der Haut und Schleimhäute kommt, die zur Bildung von Blasen und Erosionen führen können. Die einzelnen Pemphigoid-Erkrankungen weisen in ihrem klinischen Bild Ähnlichkeiten, teilweise aber auch erhebliche Unterschiede auf. Die genaue Differenzierung der einzelnen Pemphigoid-Erkrankungen ist oft nur durch eine gründliche immunpathologische Diagnostik möglich. Dies betrifft insbesondere die Differenzierung zwischen bullösem Pemphigoid, Epidermolysis bullosa acquisita und Anti-p200-Pemphigoid. Letztere ist die zuletzt definierte Pemphigoid-Erkrankung und die einzige mit immer noch unbekanntem Autoantigen. In dem vorliegenden Artikel präsentieren wir den typischen Verlauf eines Anti-p200-Pemphigoids und gehen detailliert auf die immunpathologische Diagnostik ein, die benötigt wird, um das Anti-p200-Pemphigoid von anderen Pemphigoid-Erkrankungen zu unterscheiden.
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Affiliation(s)
- M. M. Holtsche
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - D. Zillikens
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - C. D. Sadik
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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Goletz S, Probst C, Komorowski L, Schlumberger W, Fechner K, van Beek N, Holtsche MM, Recke A, Yancey KB, Hashimoto T, Antonicelli F, Di Zenzo G, Zillikens D, Stöcker W, Schmidt E. A sensitive and specific assay for the serological diagnosis of antilaminin 332 mucous membrane pemphigoid. Br J Dermatol 2019; 180:149-156. [PMID: 30216412 DOI: 10.1111/bjd.17202] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antilaminin 332 mucous membrane pemphigoid (MMP) is an autoimmune subepidermal blistering disease with predominant mucosal involvement and autoantibodies against laminin 332. Malignancies have been associated with this disease; however, no standardized detection system for antilaminin 332 serum antibodies is widely available. OBJECTIVES Development of a sensitive and specific assay for the detection of antilaminin 332 antibodies. METHODS An indirect immunofluorescence (IF) assay using recombinant laminin 332 was developed and probed with a large number of antilaminin 332 MMP patient sera (n = 93), as well as sera from patients with antilaminin 332-negative MMP (n = 153), bullous pemphigoid (n = 20), pemphigus vulgaris (n = 20) and noninflammatory dermatoses (n = 22), and healthy blood donors (n = 100). RESULTS In the novel IF assay, sensitivities with the laminin 332 heterotrimer and the individual α3, β3 and γ2 chains were 77%, 43%, 41% and 13%, respectively, with specificities of 100% for each substrate. The sensitivity for the heterotrimer increased when an anti-IgG4 enriched antitotal IgG conjugate was applied. Antilaminin 332 reactivity paralleled disease activity and was associated with malignancies in 25% of patients with antilaminin 332 MMP. CONCLUSIONS The novel IF-based assay will facilitate the serological diagnosis of antilaminin 332 MMP and may help to identify patients at risk of a malignancy.
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Affiliation(s)
- S Goletz
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - C Probst
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - L Komorowski
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - W Schlumberger
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - K Fechner
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - N van Beek
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - M M Holtsche
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - A Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - K B Yancey
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - F Antonicelli
- Department of Dermatology, University of Reims, Reims, France
| | - G Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - W Stöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - E Schmidt
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Holtsche MM, Goletz S, van Beek N, Zillikens D, Benoit S, Harman K, Walton S, English J, Sticherling M, Chapman A, Levell NJ, Groves R, Williams HC, König IR, Schmidt E. Prospective study in bullous pemphigoid: association of high serum anti-BP180 IgG levels with increased mortality and reduced Karnofsky score. Br J Dermatol 2018; 179:918-924. [PMID: 29607480 DOI: 10.1111/bjd.16553] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is a subepidermal blistering disease characterized by autoantibodies against the two hemidesmosomal proteins, BP180 (type XVII collagen) and BP230. The multicentre prospective BLISTER (Bullous Pemphigoid Steroids and Tetracyclines) trial randomized 253 patients with BP to compare the benefits and harms between initial treatment with doxycycline or prednisolone. OBJECTIVES To analyse distinct autoantibody profiles for the prediction of the disease course in a well-characterized cohort of BP sera. METHODS One hundred and forty-three patients of the BLISTER trial consented to participate in this serological study. Sera taken at baseline were analysed by (i) indirect immunofluorescence, (ii) anti-BP180 NC16A (16th noncollagenous domain) and anti-BP230 enzyme-linked immunosorbent assay and (iii) immunoblotting with various substrates. Results were then linked with clinical parameters including age, Karnofsky score, number of blisters, related adverse events and mortality. RESULTS Disease activity correlated with immunoglobulin (Ig)G anti-BP180 levels but not with levels of anti-BP230 IgG and anti-BP180 IgE. High levels of both anti-BP180 IgG and anti-BP230 IgG were associated with a low Karnofsky score. The presence of anti-BP230 IgG was more frequent in older patients. Those with higher total IgE serum levels suffered from fewer adverse events. Higher IgG anti-BP180 levels were associated with an increased 1-year mortality rate. CONCLUSIONS Analysis of the autoantibody profile is not only of diagnostic relevance but may also be helpful in predicting the course of the disease.
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Affiliation(s)
- M M Holtsche
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - N van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - K Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Leicester, U.K
| | - S Walton
- Castle Hill Hospital, Cottingham, U.K
| | - J English
- Queen's Medical Centre, University Hospital, Nottingham, U.K
| | - M Sticherling
- Department of Dermatology, University of Erlangen, Erlangen, Germany
| | - A Chapman
- Queen Elizabeth Hospital, Greenwich, London, U.K
| | - N J Levell
- Norfolk and Norwich University Hospital, Norwich, U.K
| | - R Groves
- Department of Immunodermatology, St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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