1
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Ghafari-Saravi A, Greiling TM. Recurrent bullous erythema multiforme due to oral contraceptive therapy. Int J Womens Dermatol 2024; 10:e142. [PMID: 38572265 PMCID: PMC10986911 DOI: 10.1097/jw9.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
| | - Teri M. Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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2
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Shah VK, English JC. Store-and-forward inpatient teledermatology improves care for hospitalized patients with bullous eruptions after a primary inpatient team consultation: A retrospective study. J Am Acad Dermatol 2024; 90:174-177. [PMID: 37714217 DOI: 10.1016/j.jaad.2023.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Vrusha K Shah
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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3
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Bagos-Estevez AG, Moore S, Turner L, Baldwin B. A Case of Bullous Sweet's Syndrome Associated With Esophageal Adenocarcinoma. Cureus 2024; 16:e52954. [PMID: 38406046 PMCID: PMC10894071 DOI: 10.7759/cureus.52954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, characteristically presents with fever, dermal neutrophilic infiltrates, and neutrophilia. It typically manifests as tender erythematous plaques; however, various variants are documented, including bullous. Malignancy-associated Sweet's syndrome (MASS) can present as a paraneoplastic syndrome in those with established cancers or with undiagnosed malignancies. We present a 72-year-old male with a three-day history of a progressive bullous, erythematous papular rash starting on his right forearm and spreading to his extremities, trunk, palms, and soles. It was mildly pruritic but nontender. He had no recent febrile illnesses. On examination, the rash was violaceous with tense bullae overlying edematous targetoid papules coalescing into plaques. Histopathologic analysis of punch biopsies from his abdomen and thigh demonstrated dense inflammatory infiltrates of neutrophils, eosinophils, histiocytes, and lymphocytes, suggestive of neutrophilic dermatosis, or Sweet's syndrome. He was treated with prednisone 1 mg/kg with improvement in his cutaneous symptoms, and a malignancy workup was initiated. Blood work showed elevated free kappa, lambda light chains, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels. A positron emission tomography (PET) scan revealed lesions in the esophagus and kidney. He was referred to Heme/Onc, GI, and Urology. He was diagnosed with esophageal adenocarcinoma stage IIb and a renal mass. He has since completed neoadjuvant chemotherapy and radiation, is s/p robotic Ivor-Lewis esophagectomy with no evidence of residual carcinoma on pathology, and is undergoing surveillance with imaging every three months for his renal mass. This case highlights the importance of rapid identification of MASS and the impact dermatologists can make in getting these patients the potentially lifesaving care they need.
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Affiliation(s)
| | - Sarah Moore
- Dermatology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Leslie Turner
- Dermatopathology, James A. Haley Veterans' Hospital, Tampa, USA
| | - Brooke Baldwin
- Dermatology, University of South Florida Morsani College of Medicine, Tampa, USA
- Dermatology, James A. Haley Veterans' Hospital, Tampa, USA
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4
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Hao L, Cai W, Zeng Z, Geng X, Li Q, Chen H, Zhang Y, Ding J. Toxic epidermal necrolysis after injection of sclerosing agent and medical adhesive into oesophageal variceal ligation in a patient with a malignant liver tumour: A case report. Exp Ther Med 2024; 27:20. [PMID: 38125343 PMCID: PMC10728904 DOI: 10.3892/etm.2023.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/13/2023] [Indexed: 12/23/2023] Open
Abstract
Chronic liver disease can cause an increase in portal sinus pressure, which may lead to rupture and bleeding of esophageal and gastric varices. Oesophageal variceal ligation, with use of sclerosing agent and tissue glue injection is commonly used in clinical practice to address oesophageal bleeding. A 58-year-old male patient with chronic liver disease was treated with oesophageal variceal ligation, sclerosing agent and tissue glue injection due to oesophageal and gastric variceal bleeding. After 2 days, the skin of the patient exhibited erythema to different degrees. After 10 days of dexamethasone treatment, the whole-body rash worsened, and a severe skin reaction appeared that was suggestive of toxic epidermal necrolysis (TEN). Strict mucosal care was provided, and corticosteroids, γ globulin and adalimumab were concurrently used for treatment. After 20 days, the patient recovered from the skin problems. To the best of our knowledge, TEN after endoscopic surgery has rarely been reported in the relevant literature. Furthermore, when patients being treated with multiple drugs have erythema multiforme, physicians should be alert to the possibility of its development into TEN. The present case report summarizes the treatment methods for patients with TEN, providing a practical clinical basis and direction for the future diagnosis and treatment of the condition.
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Affiliation(s)
- Liangchao Hao
- Department of Dermatology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
- Department of Plastic Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Wei Cai
- Department of Dermatology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Zhaomu Zeng
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi 330000, P.R. China
| | - Xiuchao Geng
- School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, P.R. China
| | - Qiang Li
- School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, P.R. China
| | - Hong Chen
- Department of Dermatology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Yuhao Zhang
- Department of Neurosurgery, Cancer Centre, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310000, P.R. China
| | - Juan Ding
- Department of Dermatology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
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5
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Clark A, Weissman AS, Crowson AN, Hirshburg J. Olaparib-induced pseudoporphyria in a patient with ovarian cancer. JAAD Case Rep 2023; 39:58-60. [PMID: 37583835 PMCID: PMC10424066 DOI: 10.1016/j.jdcr.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Affiliation(s)
- Abigale Clark
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Amanda S. Weissman
- Department of Dermatology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Arthur Neil Crowson
- Department of Dermatology and Pathology Laboratories Inc, University of Oklahoma, Tulsa, Oklahoma
| | - Jason Hirshburg
- Department of Dermatology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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6
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Almuhanna N, Alrashidi AR, Shaheen EA, Alanazi Y, Alfawzan A, Alharthi R, Alhomida FA. Assessing the use of dupilumab in a pediatric patient with bullous congenital ichthyosiform erythroderma. JAAD Case Rep 2023; 39:17-20. [PMID: 37560138 PMCID: PMC10407022 DOI: 10.1016/j.jdcr.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
- Nouf Almuhanna
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Anwar R. Alrashidi
- College of Medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Esraa A. Shaheen
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Yasmeen Alanazi
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Raghad Alharthi
- Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Faris A. Alhomida
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
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7
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Rossi L, Tiecco G, Venturini M, Castelli F, Quiros-Roldan E. Human Orf with Immune-Mediated Reactions: A Systematic Review. Microorganisms 2023; 11:1138. [PMID: 37317112 DOI: 10.3390/microorganisms11051138] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/16/2023] Open
Abstract
Background: Orf is a highly contagious zoonosis caused by Orf virus (ORFV), which is endemic in sheep and goats worldwide. Human Orf is usually a self-limiting disease, but potential complications, including immune-mediated reactions, may occur. Methods: We included all articles regarding Orf-associated immunological complications published in peer-reviewed medical journals. We conducted a literature search of the United States National Library of Medicine, PubMed, MEDLINE, PubMed Central, PMC, and the Cochrane Controlled Trials. Results: A total of 16 articles and 44 patients were included, prevalently Caucasian (22, 95.7%) and female (22, 57.9%). The prevailing immunological reaction was erythema multiforme (26, 59.1%), followed by bullous pemphigoid (7, 15.9%). In most cases, the diagnosis was made on the basis of clinical and epidemiological history (29, 65.9%), while a biopsy of secondary lesions was performed in 15 patients (34.1%). A total of 12 (27.3%) patients received a local or systemic treatment for primary lesions. Surgical removal of primary lesion was described in two cases (4.5%). Orf-immune-mediated reactions were treated in 22 cases (50.0%), mostly with topical corticosteroids (12, 70.6%). Clinical improvement was reported for all cases. Conclusions: Orf-related immune reactions can have a varied clinical presentation, and it is important for clinicians to be aware of this in order to make a prompt diagnosis. The main highlight of our work is the presentation of complicated Orf from an infectious diseases specialist's point of view. A better understanding of the disease and its complications is essential to achieve the correct management of cases.
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Affiliation(s)
- Luca Rossi
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Tiecco
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Marina Venturini
- Department of Clinical and Experimental Sciences, Section of Dermatology, University of Brescia, 25123 Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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8
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Mahmood F, Cyr J, Li A, Lipson J, Pratt M, Beecker J. Vesiculo bullous and Other Cutaneous Manifestations of COVID-19 Vaccines: a Scoping and Narrative Review. J Cutan Med Surg 2023:12034754231156561. [PMID: 36789514 DOI: 10.1177/12034754231156561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
As coronavirus disease (COVID-19) vaccines continue to be administered, dermatologists play a critical role in recognizing and treating the cutaneous manifestations (CM) associated with the vaccines. Adverse cutaneous reactions of COVID-19 vaccines reported in the literature range from common urticarial to rare vesiculobullous reactions. In this study, we performed a (1) scoping review to assess the occurrences of vesicular, papulovesicular, and bullous CMs of COVID-19 vaccines and their respective treatments, and (2) a narrative review discussing other common and uncommon CMs of COVID-19 vaccines. Thirty-six articles were included in the scoping review, and 66 articles in the narrative review. We found that vesicular, papulovesicular, and bullous lesions are infrequent, reported mostly after the first dose of Moderna or Pfizer vaccines. Eleven of the 36 studies reported vesicular reactions consistent with activation or reactivation of the herpes zoster virus. Most vesicular and bullous lesions were self-limited or treated with topical corticosteroids. Other CMs included injection-site, urticarial or morbilliform reactions, vasculitis, toxic epidermal necrolysis, and flaring of or new-onset skin diseases such as psoriasis. Treatments for CMs included topical or oral corticosteroids, antihistamines, or no treatment in self-limited cases. Although most CMs are benign and treatable, the data on the effect of systemic corticosteroids and immunosuppressive therapies on the immunogenicity of COVID-19 vaccines is limited. Some studies report reduced immunogenicity of the vaccines after high-dose corticosteroids use. Physicians may consult local guidelines where available when recommending COVID-19 vaccines to immunosuppressed patients, and when using corticosteroids to manage the CMs of COVID-19 vaccines.
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Affiliation(s)
- Farhan Mahmood
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Janelle Cyr
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6363 Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Amy Li
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Lipson
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6363 Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Melanie Pratt
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6363 Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jennifer Beecker
- 15300612365 Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6363 Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
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9
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So N, Gin A. Bullous hand dermatitis following exposure to iodinated radiographic contrast media. Australas J Dermatol 2023; 64:e93-e95. [PMID: 36541792 DOI: 10.1111/ajd.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Neda So
- Western Health, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alexander Gin
- Western Health, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
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10
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Parisi R, Shah H, Shear NH, Ziv M, Markova A, Dodiuk-Gad RP. A Review of Bullous Dermatologic Adverse Events Associated with Anti-Cancer Therapy. Biomedicines 2023; 11:biomedicines11020323. [PMID: 36830860 PMCID: PMC9953054 DOI: 10.3390/biomedicines11020323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The rapid evolution of anti-cancer therapy (including chemotherapy, targeted therapy, and immunotherapy) in recent years has led to a more favorable efficacy and safety profile for a growing cancer population, and the improvement of overall survival and reduction of morbidity for many cancers. Anti-cancer therapy improves outcomes for cancer patients; however, many classes of anti-cancer therapy have been implicated in the induction of bullous dermatologic adverse events (DAE), leading to reduced patient quality of life and in some cases discontinuation of life-prolonging or palliative therapy. Timely and effective management of adverse events is critical for reducing treatment interruptions and preserving an anti-tumor effect. Bullous DAE may be limited to the skin or have systemic involvement with greater risk of morbidity and mortality. We present the epidemiology, diagnosis, pathogenesis, and management of bullous DAE secondary to anti-cancer therapies to enable clinicians to optimize management for these patients.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, NY 12208, USA
| | - Hemali Shah
- Albany Medical College, Albany, NY 12208, USA
| | - Neil H. Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10021, USA
- Correspondence:
| | - Roni P. Dodiuk-Gad
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa 3525433, Israel
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11
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Daftary K, Chovatiya R. Unilateral and localized bullous eruption in a 71-year-old woman. Skin (Milwood) 2023; 7:635-637. [PMID: 37096214 PMCID: PMC10122832 DOI: 10.25251/skin.7.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Karishma Daftary
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL USA
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12
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Asnawi V, Maulida M, Hidayati A, Gunawan H, Dwiyana RF, Hindritiani R. Combination of Crusted Scabies with Bullous Scabies: A Rare Case. Int Med Case Rep J 2023; 16:153-158. [PMID: 36936186 PMCID: PMC10018284 DOI: 10.2147/imcrj.s396234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023] Open
Abstract
Scabies is a parasitic skin disease caused by Sarcoptes scabiei var. hominis. Crusted scabies, also known as Norwegian scabies, is a rare and severe form of scabies that occurs more frequently in immunocompromised, elderly, disabled, and debilitated patients. The present study reports a case of crusted scabies combined with bullous scabies. A 44-year-old man was admitted with the chief complaint of red, thick, scaly patches of skin accompanied by crusting that felt itchy and worsened at night. The lesions had appeared all over his body intermittently for the last 10 years; however, the complaints worsened in the last 2 months. From dermatological status, the anterior and posterior thoracic regions and between the fingers of both hands showed generalized distribution of erythematous, yellowish, hyperkeratotic plaques with clear boundaries, pustules, and blisters on an erythematous base with multiple erosions and excoriations. S. scabiei were found on skin scraping examination, and histopathological examination supported the diagnosis of bullous scabies. The patient received 5% permethrin lotion topical therapy and systemic ivermectin therapy. In addition, the patient was given systemic antibiotics. The lesions improved after 2 weeks of therapy, and no S. scabiei were found on the subsequent microscopic examination. Treatment with a combination of topical and systemic scabicidal agents produced a favorable outcome in this patient.
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Affiliation(s)
- Vella Asnawi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin General Hospital, Banda Aceh, Aceh, Indonesia
- Correspondence: Vella Asnawi, Department of Dermatology and Venereology, Dr. Zainoel Abidin General Hospital, Jl. Tgk.Daud Beureueh No. 108, Banda Aceh, Aceh, Indonesia, Tel +6281938199931, Email
| | - Mimi Maulida
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin General Hospital, Banda Aceh, Aceh, Indonesia
| | - Arie Hidayati
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin General Hospital, Banda Aceh, Aceh, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Dermatology and Venereology, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Dermatology and Venereology, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Dermatology and Venereology, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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13
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Nakahara Y, Yamane M, Sunada M, Aoyama Y. SARS-CoV-2 vaccine-triggered conversion from systemic lupus erythematosus (SLE) to bullous SLE and dipeptidyl peptidase 4 inhibitors-associated bullous pemphigoid. J Dermatol 2022; 50:162-165. [PMID: 36578130 PMCID: PMC9880653 DOI: 10.1111/1346-8138.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare blistering disease in patients with SLE. BSLE is a heterogenous disease caused by autoantibodies to the basement membrane, mainly type VII collagen. The pathogenesis of the development of autoantibodies in BSLE remains unknown. We report a case of SLE taking dipeptidyl peptidase 4 inhibitors (DPP4i) who developed tense blister lesions after administration of SARS-CoV-2 vaccine. Initial erythematous lesion before administration of SARS-CoV-2 vaccine had not shown IgG deposition at basement membrane both direct and indirect immunofluorescence (IIF). However, the result of those examinations became positive after the administration of SARS-CoV-2 vaccine. Furthermore, IIF test results using NaCl split skin had shown positive against epidermal side. These observations suggest that SARS-CoV-2 vaccination triggered production of autoantibodies that cause bullous SLE. The present case fulfills the diagnostic criteria for both BSLE and DPP4i-associated bullous pemphigoid. Skin lesions were cleared after withdrawal of DPP4i. Therefore, physicians should ask patients who develop blisters after the vaccination whether they are taking DPP4i.
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Affiliation(s)
- Yukiko Nakahara
- Department of DermatologyKawasaki Medical SchoolOkayamaJapan
| | - Mariko Yamane
- Department of DermatologyKawasaki Medical SchoolOkayamaJapan
| | - Midori Sunada
- Department of DermatologyKawasaki Medical SchoolOkayamaJapan
| | - Yumi Aoyama
- Department of DermatologyKawasaki Medical SchoolOkayamaJapan
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14
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Youssef RM, Saleh MA, Korany MM, Nour ZA, El-Kalioby M. Assessment of tissue E-cadherin and its proteolytic serum fragment in pemphigus vulgaris before and after remission: A case-control study. J Cosmet Dermatol 2022; 21:6343-6350. [PMID: 35912419 DOI: 10.1111/jocd.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND E-cadherin is a classic cadherin that mediates keratinocyte adhesion. AIMS To assess the tissue expression of E-cadherin and its proteolytic serum fragment (soluble E-cadherin) in pemphigus vulgaris (PV) before and after clinical remission compared with controls. PATIENTS Thirty-seven PV patients and thirty controls were enrolled. Pemphigus disease area index (PDAI) was calculated for patients at baseline and after remission. Punch biopsy specimens were taken from patients before, and after remission, and from controls for assessment of tissue E-cadherin by immunofluorescence. Similarly, serum samples were collected for assessment of serum soluble E-cadherin by ELISA. RESULTS Presence, intensity, and mean intensity of tissue E-cadherin were significantly reduced in PV patients before treatment compared with controls (p < 0.001). Detected E-cadherin showed mainly a basal and suprabasal distribution with cell surface and a cytoplasmic expression. Serum E-cadherin was significantly higher in patients before treatment compared with controls (p = 0.006). With remission, tissue E-cadherin presence, intensity, mean intensity, and serum E-cadherin showed statistically significant improvement (p = 0.003, <0.001, <0.001, and 0.003 respectively). Tissue E-cadherin presence and serum E-cadherin level reached values equivalent to the controls (p = 0.49 and 0.44, respectively). CONCLUSIONS Disruption of tissue E-cadherin and upregulation of serum soluble E-cadherin can contribute to the pathogenesis of PV. Clinical remission of PV is associated with normalization of tissue and serum E-cadherin.
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Affiliation(s)
| | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Mostafa Korany
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Zeinab A Nour
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona El-Kalioby
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Pangastuti M, Rizqandaru T, Suwarsa O, Dharmadji HP, Sutedja E. Multiple Bullous and Ulcers as Cutaneous Manifestations of Wegener's Granulomatosis: A Rare Case Report. Clin Cosmet Investig Dermatol 2022; 15:2159-2164. [PMID: 36238442 PMCID: PMC9552674 DOI: 10.2147/ccid.s385464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
Bullous dermatoses is a heterogeneous group of blistering skin disorders that can either be inherited or acquired. Subepidermal blisters may result in ulceration and scarring following their rupture. Wegener’s granulomatosis (WG) is a granulomatous necrotizing vasculitis affecting small- to medium-sized blood vessels. It is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and can be manifested cutaneously as multiple bullous and ulcers. A case of WG was reported in an 18-year-old man presented with multiple skin bullous and ulcers. The patient was diagnosed with WG based on the findings from nasopharyngoscopy examination that revealed crusts in his nasal cavity; necrotizing granulomatous appearance on chest radiograph; hematuria on urinalysis; and positive ANCA blood test. This patient received a combination of methylprednisolone and methotrexate, resulting in improvement within four weeks of therapy. His multiple skin ulcers were treated with a combination of dialkyl carbamoyl chloride, hydrocolloid, and hydrogel dressings. This patient was in complete remission state after six months of treatment, which later followed by a relapse episode that occurred within one year. WG with multiple skin bullous and ulcers can mimic other diseases. Various examinations such as histopathology, direct immunofluorescence, and ANCA blood test may aid in determining the etiology of skin bullous and ulcers.
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Affiliation(s)
- Miranti Pangastuti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia,Correspondence: Miranti Pangastuti, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281223114874, Email
| | - Trustia Rizqandaru
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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16
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Wang SH, Zuo YG. [Interpretation of 2021 French Guidelines for the Therapeutic Management of Bullous Pemphigoid]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:828-836. [PMID: 36325781 DOI: 10.3881/j.issn.1000-503x.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Bullous pemphigoid (BP) is a common autoimmune subepidermal bullous disease.The diagnosis of BP relies on clinical manifestation,histopathology,direct and indirect immunofluorescence,and serological assay.In the past two decades,topical corticosteroids and systemic and/or topical corticosteroids were the major therapeutic options for localized/mild/moderate and extensive/severe BP,respectively.In 2021,several experts from the French Study Group on Autoimmune Bullous Skin Diseases collaboratively issued the updated guidelines for the therapeutic management of BP based on evidence-based medicine.The guidelines fully detailed the updated therapeutic options for extensive BP,BP of limited extent,localized form of BP,corticosteroid-dependent BP,and drug-induced/associated BP.In particular,systemic corticosteroids are no longer the first-line treatment for extensive BP.We interpret the guidelines to assist dermatologists in the comprehensive management of BP and promote the standardization of BP treatment.
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Affiliation(s)
- Si-Hang Wang
- State Key Laboratory of Complex Severe and Rare Diseases,National Clinical Research Center for Dermatologic and Immunologic Diseases,Department of Dermatology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Ya-Gang Zuo
- State Key Laboratory of Complex Severe and Rare Diseases,National Clinical Research Center for Dermatologic and Immunologic Diseases,Department of Dermatology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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17
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Yuan Y, Wang CJ, Li H. Extragenital Bullous Lichen Sclerosus Treated with Fractional CO 2 Laser (FxCO 2) and Wet Dressing of Halcinonide Solution: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:427-431. [PMID: 35300434 PMCID: PMC8921669 DOI: 10.2147/ccid.s355111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosis (LS) is an insidious, chronic, relapsing skin disease characterized by atrophic, porcelain-appearing plaques. It usually arises in the anogenital area, but some cases can present in extragenital regions with a variety of presentations, including a bullous variant. Topical corticosteroids are a first-line therapy and are usually the most effective treatment to induce remission of LS. However, there is a subset of patients that does not respond well to topical steroids. Herein, we report an extragenital bullous LS case successfully treated with a fractional CO2 laser (FxCO2) and subsequent wet dressing of halcinonide solution.
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Affiliation(s)
- Yunyan Yuan
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Caroline J Wang
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Houmin Li
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
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18
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Vázquez-Osorio I, Moreiras-Arias N, Pérez-Feal P, Sainz-Gaspar L, Ortiz-Cabrera NV, Hernández-Martín A. Scabies in a 14-year-old girl with superficial epidermolytic ichthyosis. Pediatr Dermatol 2022; 39:305-306. [PMID: 34779035 DOI: 10.1111/pde.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 14-year-old girl who reported generalized scaling and hyperkeratosis since age 1 year presented with severe pruritus of several months' duration. Scabies mites were detected, and molecular genetic analysis subsequently revealed a rare pathogenic variant in the keratin 2 (KRT2) gene, confirming a diagnosis of superficial epidermolytic ichthyosis. Treatment with oral ivermectin led to complete remission of symptoms. Disorders of keratinization can mimic clinical signs of scabies, leading to a delay in diagnosis.
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Affiliation(s)
- Igor Vázquez-Osorio
- Department of Dermatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Noelia Moreiras-Arias
- Department of Dermatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Pérez-Feal
- Department of Dermatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Sainz-Gaspar
- Department of Dermatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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19
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Zhong LS, Huang BQ, Tang WT, Zhuo ZQ. Bullous impetigo-like irritant contact dermatitis caused by perfume. Pediatr Dermatol 2022; 39:320-321. [PMID: 35014095 DOI: 10.1111/pde.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 11/30/2022]
Abstract
Contact dermatitis usually presents as erythematous macules, papules, and vesicles. Sometimes, unusual clinical presentations of contact dermatitis are reported, including pustular, lymphomatoid, lichenoid, and pigmented variants. We describe the first patient with bullous irritant contact dermatitis caused by perfume, mimicking impetigo lesions. We report this case to raise awareness concerning the possibility of serious cutaneous reactions, such as bullous impetigo-like irritant contact dermatitis due to perfumes which are ubiquitous, especially after direct contact with the solution. Perfume ingredients, such as fragrance, solvents, and preservatives all may cause or contribute to irritant contact dermatitis.
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Affiliation(s)
- Lian-Sheng Zhong
- Department of Dermatology, Xiamen Children's Hospital, Xiamen, China
| | - Bing-Qing Huang
- Department of Infectious Disease, Xiamen Children's Hospital, Xiamen, China
| | - Wen-Tao Tang
- Department of Infectious Disease, Xiamen Children's Hospital, Xiamen, China
| | - Zhi-Qiang Zhuo
- Department of Infectious Disease, Xiamen Children's Hospital, Xiamen, China
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20
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Papara C, Danescu S, Sitaru C, Baican A. Challenges and pitfalls between lichen planus pemphigoides and bullous lichen planus. Australas J Dermatol 2022; 63:165-171. [PMID: 35196400 DOI: 10.1111/ajd.13808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 12/20/2022]
Abstract
Lichen planus pemphigoides (LPP) and bullous lichen planus (BLP) are rare dermatoses, which are characterised by blisters and lichenoid lesions. Their clinical presentation is heterogenous, displaying overlapping features or mimicking other dermatological diseases. Therefore, diagnosis can often be challenging, requiring a thorough dermatological examination along with distinctive histological and immunopathological characteristics. Lichenoid degeneration of the basal epidermis exposes various antigens of the dermal-epidermal junction in LPP, resulting in the breakdown of immune tolerance, hence, the production of autoantibodies against type XVII collagen. Conversely, no pathogenic autoantibodies are detected in BLP. However, some cases of mucosal lichen planus might display immunopathological features suggestive of autoimmune blistering diseases. Therefore, a better understanding of the pathophysiology of these two distinct dermatoses is imperative. The aim of this review was to provide a summary of the current knowledge on the clinical hallmarks, diagnosis and available therapeutic options in LPP and BLP.
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Affiliation(s)
- Cristian Papara
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorina Danescu
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cassian Sitaru
- Centre for Biological Signaling Studies (BIOSS), University of Freiburg, Freiburg, Germany
| | - Adrian Baican
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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21
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Shah R, Jamgochian M, Haroon A, Pappert A, Miller J. A 14-year-old with dermatitis artefacta secondary to aerosolized spray deodorant: A rare case with an important learning opportunity. JAAD Case Rep 2021; 19:71-73. [PMID: 34917729 PMCID: PMC8669259 DOI: 10.1016/j.jdcr.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rohan Shah
- Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Attiya Haroon
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Amy Pappert
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Jason Miller
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
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22
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Bal A, Sorensen A, Ondreyco SM. Non bullous erythrodermic pemphigoid with florid lymphadenopathy, response to dupilumab. JAAD Case Rep 2021; 17:58-60. [PMID: 34703867 PMCID: PMC8523979 DOI: 10.1016/j.jdcr.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Arjun Bal
- Arizona College of Osteopathic Medicine - Midwestern University, Glendale, Arizona
| | - Adam Sorensen
- Fellow of the American Academy of Dermatology North Valley Dermatology, Peoria, Arizona
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23
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Pratasava V, Sahni VN, Suresh A, Huang S, Are A, Hsu S, Motaparthi K. Bullous Pemphigoid and Other Pemphigoid Dermatoses. Medicina (Kaunas) 2021; 57:medicina57101061. [PMID: 34684098 PMCID: PMC8539012 DOI: 10.3390/medicina57101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
The pemphigoid family of dermatoses is characterized by autoimmune subepidermal blistering. The classic paradigm for pemphigoid, and the most common member, is bullous pemphigoid. Its variable clinical presentation, with or without frank bullae, is linked by significant pruritus afflicting the elderly. Mucous membrane pemphigoid is an umbrella term for a group of subepidermal blistering dermatoses that favor the mucosal membranes and can scar. Epidermolysis bullosa acquisita is a chronic blistering disorder characterized by skin fragility, sensitivity to trauma, and its treatment-refractory nature. Clinicians that encounter these pemphigoid disorders may benefit from an overview of their clinical presentation, diagnostic work-up, and therapeutic management, with an emphasis on the most frequently encountered pemphigoid disease, bullous pemphigoid.
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Affiliation(s)
- Valeryia Pratasava
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (V.P.); (V.N.S.); (A.S.)
| | - Vikram N. Sahni
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (V.P.); (V.N.S.); (A.S.)
| | - Aishwarya Suresh
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (V.P.); (V.N.S.); (A.S.)
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Abhirup Are
- College of Medicine, University of Florida, Gainesville, FL 32606, USA;
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Kiran Motaparthi
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL 32606, USA
- Correspondence:
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24
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Nguyen CN, Kim SJ. Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management. Medicina (Kaunas) 2021; 57:843. [PMID: 34441049 DOI: 10.3390/medicina57080843] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022]
Abstract
Dermatitis herpetiformis (DH), Duhring disease, is caused by gluten sensitivity and affects 11.2 to 75.3 per 100,000 people in the United States and Europe with an incidence of 0.4 to 3.5 per 100,000 people per year. DH is characterized by a symmetrical blistering rash on the extensor surfaces with severe pruritus. The diagnosis continues to be made primarily by pathognomonic findings on histopathology, especially direct immunofluorescence (DIF). Recently, anti-epidermal transglutaminase (TG3) antibodies have shown to be a primary diagnostic serology, while anti-tissue transglutaminase (TG2) and other autoantibodies may be used to support the diagnosis and for disease monitoring. Newly diagnosed patients with DH should be screened and assessed for associated diseases and complications. A gluten-free diet (GFD) and dapsone are still mainstays of treatment, but other medications may be necessary for recalcitrant cases. Well-controlled DH patients, managed by a dermatologist, a gastroenterologist, and a dietician, have an excellent prognosis. Our review comprehensively details the current diagnostic methods, as well as methods used to monitor its disease course. We also describe both the traditional and novel management options reported in the literature.
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Abstract
Dyshidrosiform bullous pemphigoid is a variant of bullous pemphigoid. At least 84 patients with dyshidrosiform bullous pemphigoid have been described. Dyshidrosiform bullous pemphigoid usually presents with pruritic blisters in elderly individuals; the hemorrhagic or purpuric lesions on the palms and soles can be the only manifestation of the disease. However, bullae may concurrently or subsequently appear on other areas of the patient's body. Patients typically improve after the diagnosis is established and treatment is initiated. The mainstay of therapy is systemic corticosteroids, with or without topical corticosteroids, and systemic dapsone or immunosuppressants. Drug-related or nickel-induced dyshidrosiform bullous pemphigoid improves after stopping the associated agent; however, systemic therapy has also been required to achieve resolution of the blisters. Similar to classic bullous pemphigoid, neurologic conditions and psychiatric disorders have been observed in dyshidrosiform bullous pemphigoid patients. The new onset of recurrent or persistent blisters on the palms, soles, or both of an elderly individual should prompt the clinician to consider the diagnosis of dyshidrosiform bullous pemphigoid.
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26
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Endo H, Rees TD, Niwa H, Kuyama K, Oshima M, Serizawa T, Tanaka S, Iijima M, Komiya M. High frequency of upper aerodigestive tract manifestations in mucous membrane pemphigoid. Oral Dis 2021; 28:1555-1560. [PMID: 33835636 DOI: 10.1111/odi.13872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the frequency of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid associated with desquamative gingivitis. SUBJECTS AND METHODS Data from 25 patients were collected by retrospective chart review. Their upper aerodigestive had been evaluated using a conventional flexible fiberscope. Oral disease activity was quantified on the basis of the Mucous Membrane Pemphigoid Disease Area Index activity score. RESULTS Lesions of the upper aerodigestive tract were confirmed in nine symptomatic patients (9/25, 36%), of which five (5/25, 20%) had laryngeal involvement. No lesions were seen in the asymptomatic patients on fiberscope examination. There was a statistically significant difference in the symptoms, high oral disease activity score, and linear IgA deposition on direct immunofluorescence between patients with and without upper aerodigestive tract lesions (p = .001, .001, .002, respectively). CONCLUSION The high frequency of considerable complications highlights the importance of confirming the presence of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid having desquamative gingivitis. Signs including the presence of symptoms, high oral disease activity score, or linear IgA deposition on direct immunofluorescence might indicate a higher risk of upper aerodigestive tract involvement.
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Affiliation(s)
- Hiroyasu Endo
- Department of Oral Diagnostics, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Terry D Rees
- Department of Periodontics, Texas A&M College of Dentistry, Dallas, TX, USA
| | - Hideo Niwa
- Department of Neurosurgery and Head and Neck Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Kayo Kuyama
- Department of Pathology, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Maya Oshima
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Tae Serizawa
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Shigeo Tanaka
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Morio Iijima
- Department of Removable Prosthodontics, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Masamichi Komiya
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
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Kawall T, Seecheran R, Seecheran V, Persad S, Seecheran NA. Suspected Ticagrelor-Induced Bullous Fixed Drug Eruption. Cureus 2021; 13:e13890. [PMID: 33880246 PMCID: PMC8045002 DOI: 10.7759/cureus.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe a case of a suspected cutaneous hypersensitivity reaction to ticagrelor. The patient displayed a localized bullous fixed drug eruption after being loaded with ticagrelor, which resolved with oral antihistamines and topical steroids after one week. Clopidogrel and rivaroxaban were successfully administered as alternative antithrombotic therapy without any apparent further hypersensitivity skin reaction.
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Affiliation(s)
- Tiffany Kawall
- Internal Medicine, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Rajeev Seecheran
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
| | - Valmiki Seecheran
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
| | - Sangeeta Persad
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
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Affiliation(s)
| | - Nhan M. Nguyen
- Houston Methodist, Department of Dermatology, Houston, Texas
| | - Leonard H. Goldberg
- Houston Methodist, Department of Dermatology, Houston, Texas
- DermSurgery Associates, Houston, Texas
- Correspondence to: Leonard H. Goldberg, MD, DermSurgery Associates, 7515 S Main St, Ste 240, Houston, TX 77030.
| | - Sonal A. Parikh
- Houston Methodist, Department of Dermatology, Houston, Texas
| | - Maya J. Sinai
- Houston Methodist, Department of Dermatology, Houston, Texas
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29
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Watson N, Carrozzo M, Hampton P. A retrospective cohort study reporting rituximab treatment for 33 patients with immuno bullous disease. J Oral Pathol Med 2020; 50:92-97. [PMID: 33184901 DOI: 10.1111/jop.13123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autoimmune bullous disorders, encompassing pemphigus and pemphigoid diseases, are associated with significant morbidity and mortality. This is in part due to high cumulative doses of corticosteroids in combination with immunosuppressant agents used in traditional treatment regimes. Rituximab is an antiCD20 monoclonal antibody which can induce complete remission, but it is currently unlicensed in the UK and approved only after other treatments have failed. METHODS We report a retrospective cohort study of 33 patients with pemphigus and pemphigoid diseases treated with rituximab from a single tertiary centre from 2013 to 2019. RESULTS "Complete remission off therapy" was achieved by 27.3% (n = 9), and a further 27.3% (n = 9) had complete remission on minimal therapy. Twenty-one per cent (n = 7) had "partial remission on minimal therapy"; 9.1% (n = 3) patients were in the "consolidation phase," and 12.1% (n = 4) had a "relapse/flare." A steady reduction in prednisolone doses was observed post-Rituximab infusion. Pre-Rituximab the median dose of prednisolone was 20mg (range 10-35, IQR 25), 15mg (range 9.5-22.5, IQR 13) at 1 month, 9mg (range 5-10, IQR 5) at 6 months, 4mg (range 0-5mg, IQR 5) at 12 months and 0 (0-4.35, IQR 4.25) at 18 months. Twelve per cent (n = 4) of patients had documented infusion reaction symptoms. Twelve per cent (n = 4) had later infective complications. CONCLUSION This real clinic data adds to the evidence that Rituximab is a safe and effective treatment for both pemphigus and pemphigoid autoimmune blistering conditions. Significantly, we were able to demonstrate a substantial reduction in corticosteroid dosage in our cohort of patients following rituximab treatment.
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Affiliation(s)
- Nicola Watson
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Marco Carrozzo
- School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Philip Hampton
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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30
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Brown H, Lamrock E, Jenkins D. Bullous pemphigoid in adolescence, a rare demographic. Australas J Dermatol 2020; 62:e95-e97. [PMID: 32935855 DOI: 10.1111/ajd.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
Bullous pemphigoid is rarely seen in adolescence, and its presentation, clinical course, and treatment can differ to that found in other age groups. We present a case of bullous pemphigoid in a 16-year-old with features of koebnerisation and oral mucosal involvement and provide a brief review of paediatric bullous pemphigoid.
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Affiliation(s)
- Hilary Brown
- Kotara Family Practice, Kotara, New South Wales, Australia
| | - Edwina Lamrock
- Department of Dermatology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - David Jenkins
- Department of Dermatology, John Hunter Hospital, New Lambton, New South Wales, Australia
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31
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Di Lernia V, Casanova DM, Goldust M, Ricci C. Pemphigus Vulgaris and Bullous Pemphigoid: Update on Diagnosis and Treatment. Dermatol Pract Concept 2020; 10:e2020050. [PMID: 32642305 DOI: 10.5826/dpc.1003a50] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Autoimmune bullous disorders are a heterogeneous spectrum of skin disorders characterized by the production of autoantibodies against adhesion molecules of the skin. The 2 major groups of diseases are "pemphigus diseases" and "autoimmune bullous diseases of the pemphigoid type." Pemphigus diseases are a group of autoimmune blistering diseases of the skin and mucous membranes characterized by intraepithelial cleft and acantholysis. The main subtypes of pemphigus include pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus. Diagnosis is based on clinical manifestations and confirmed with histological, immunofluorescence, and serological testing. Recently multivariant enzyme-linked immunosorbent assay systems have been developed as practical screening tools for patients with suspected autoimmune bullous dermatoses. The current first-line treatment of pemphigus is based on systemic corticosteroids that are often combined with immunosuppressive adjuvants, such as azathioprine, mycophenolate mofetil, and the anti-CD20 monoclonal antibody rituximab, usually at initiation of treatment. Rituximab efficacy is higher when it is administered early in the course of the disease. Therefore, it should be used as first-line treatment to improve efficacy and reduce cumulative doses of corticosteroids and their side effects. Treatment of bullous pemphigoid is based on disease extension. Localized and mild forms can be treated with superpotent topical corticosteroids or with nonimmunosuppressive agents. In patients with generalized disease or whose disease is resistant to the treatments described above, systemic corticosteroids are preferred and effective. Adjuvant immunosuppressants are often combined with steroids for their steroid-sparing effect.
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Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Dahiana M Casanova
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Mohamad Goldust
- University Guglielmo Marconi, Rome, Italy & Department of Dermatology, University Hospital, Basel, Switzerland
| | - Cinzia Ricci
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
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Affiliation(s)
- Brent Folsom
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Tom Raisanen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
- Correspondence to: Tom Raisanen, MD, 1910 Taubman Center, 500 E. Medical Center Dr, SPC 5314, Ann Arbor, MI 48109.
| | - Milad Eshaq
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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Abstract
Bullous pemphigoid is an autoimmune blistering disorder that typically presents in elderly patients as pruritic tense subepidermal blisters on the lower trunk, axilla, and groin. It is caused by circulating and tissue-bound autoantibodies directed against bullous pemphigoid antigen 1 or bullous pemphigoid antigen 2 or both. Dyshidrosiform bullous pemphigoid is a rare variant of bullous pemphigoid, and it usually presents as itchy, potentially hemorrhagic, or purpuric blisters on the palms and/or soles of elderly individuals; subsequently, typical bullous lesions of bullous pemphigoid appear on other body sites. In our study, we report the features of two men with dyshidrosiform bullous pemphigoid and review the characteristics of individuals with this rare subtype of bullous pemphigoid. Including the men whose condition is described in this paper, at least 72 patients with dyshidrosiform bullous pemphigoid have been reported so far. However, complete features of the condition have not been described for all of the individuals. Based on the cases reported so far, the condition was slightly more common in women and the onset of the disease, for most of the patients, occurred between the ages of 61 and 94 years. The patients usually presented with blisters on both their palms and soles (66%) or just their soles (31%); 77% of the patients had progression of bullous pemphigoid to other areas of their body. Whether hemorrhagic blisters or purpuric lesions are associated with dyshidrosiform bullous pemphigoid remains to be determined; these features were present in 91% of the 22 patients who were described in the case reports yet were only observed in 5% of the individuals from a single larger series of 20 patients. The mainstay of therapy for dyshidrosiform bullous pemphigoid is systemic corticosteroids, with or without topical corticosteroids, and/or systemic dapsone or immunosuppressants; nearly all of the patients showed improvement after the treatment was initiated. Similar to individuals with bullous pemphigoid, at least nine of the dyshidrosiform bullous pemphigoid patients, including both patients in this report, had either a neurologic condition (seven patients) or both a neurologic condition and a psychiatric disorder (two patients). Usually, an autoimmune bullous disease, particularly dyshidrosiform bullous pemphigoid, is not initially considered in patients who present with blisters restricted to the palms and/or soles. Indeed, the lesion morphology of dyshidrosiform bullous pemphigoid mimics several other conditions that are characterized by blisters on the hands and feet, such as allergic and irritant contact dermatitis, chronic bullous disease of childhood, cutaneous T-cell lymphoma, dermatophyte infection, dyshidrosis or pompholyx, epidermolysis bullosa acquisita, erythema multiforme, herpes gestationis, lichen planus, linear IgA disease, scabies, and systemic contact dermatitis. In conclusion, the possibility of dyshidrosiform bullous pemphigoid should be considered in elderly individuals who present with the new onset of palmar and/or plantar blisters that are either recurrent or recalcitrant to therapy or would subsequently also appear on other areas of the body.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, San Diego, USA
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Togo S, Ozawa K, Fujii A, Tanii T, Tsuruta D, Ishii N, Hashimoto T, Tadokoro T, Isei T. Neutrophil-rich Variant of Persistent Bullous Grover's Disease. Acta Derm Venereol 2019; 99:1282-1283. [PMID: 31513276 DOI: 10.2340/00015555-3316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sayaka Togo
- Department of Dermatology, Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka 540-0006, Japan
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Ozturk M, An I. Clinical features and etiology of patients with erythema ab igne: A retrospective multicenter study. J Cosmet Dermatol 2019; 19:1774-1779. [PMID: 31696628 DOI: 10.1111/jocd.13210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the demographic and clinical features, etiology of patients with erythema ab igne (EAI) who presented to our clinics. MATERIALS AND METHODS The present study was conducted on 71 patients who were admitted to our dermatology clinics between April 2018 and June 2019 and were diagnosed with EAI by clinical or histopathological examination. Age, gender, localization of lesions, and etiologic causes of lesions were recorded. RESULTS Of the 71 patients, 48 (67.6%) were women and 23 (32.4%) were men. The mean age of the patients was 28.6 ± 10.4 years. Most of the lesions were localized (60.6%, n = 43) on the anterior aspect of both legs. Among the etiological reasons, 53 (74.6%) patients had exposure to heater, 14 (19.7%) patients had exposure to stove, 2 (2.8%) patients had laptop use, 1 (1.4%) patient had tandoor contact, and 1 (1.4%) patient had exposure to hot water bag. One patient was diagnosed with bullous EAI. CONCLUSION In conclusion, EAI was also more common in females and lower extremities, which is in accordance with the literature. However, the mean age of occurrence in our study is younger when compared with that in the literature. One case of EAI due to the use of tandoor in our study has not been reported previously. It should be kept in mind that bullous EAI may develop in patients with diabetes mellitus.
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Affiliation(s)
- Murat Ozturk
- Department of Dermatology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Isa An
- Department of Dermatology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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Abstract
Well-known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc-depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re-epithelialization of previously denuded skin.
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Affiliation(s)
- Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Suneet Bhansali
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Nooshin Brinster
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Yasir M Al-Qaqaa
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Vikash Oza
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
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Sarikaya Solak S, Ficicioglu S. Cephalosporin-induced linear IgA dermatosis in a child: Case report and literature review. Dermatol Ther 2019; 32:e12927. [PMID: 30977941 DOI: 10.1111/dth.12927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Linear IgA dermatosis (LAD) is a rare, subepidermal blistering disease with mucocutaneous involvement. It may be idiopathic or drug induced. We describe a 4-year-old girl who presented with a vesiculobullous eruption after she had been treated with cefixime for urinary tract infection. A diagnosis of drug-induced LAD was made based on clinical, histopathological, and immunofluorescence findings. Naranjo adverse drug reaction algorithm was used to assess imputability resulting with a "probable" association. In literature, cephalosporin antibiotics are rarely reported in association with LAD. To our knowledge, this is the first case of a cefixime-induced LAD among adults and children.
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Affiliation(s)
- Sezgi Sarikaya Solak
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
| | - Sezin Ficicioglu
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
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Nasiri S, Bidari Zerehpoosh F, Dadkhahfar S, Mortazavi N, Mozafari N. An infant with diffuse bullous lesions. Arch Dis Child 2018; 103:335. [PMID: 28550148 DOI: 10.1136/archdischild-2017-312704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Soheila Nasiri
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari Zerehpoosh
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Loghman-Hakim Hospital, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafiseh Mortazavi
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Loghman-Hakim Hospital, Tehran, Iran
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chen SX, Cohen PR. Cutaneous Leukocytoclastic Vasculitis Following Influenza Vaccination in Older Adults: Report of Bullous Purpura in an Octogenarian after Influenza Vaccine Administration. Cureus 2018; 10:e2323. [PMID: 29765791 PMCID: PMC5951600 DOI: 10.7759/cureus.2323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/14/2018] [Indexed: 11/05/2022] Open
Abstract
The influenza vaccination is recommended annually for protection against influenza infection. Adults over 65 years of age are especially vulnerable to complications from influenza infection; in addition, they constitute the largest group of influenza vaccination recipients each year. Cutaneous leukocytoclastic vasculitis involves inflammation of small vessel walls by neutrophils. An 88-year-old man with a history of idiopathic pulmonary fibrosis who developed bullous cutaneous leukocytoclastic vasculitis 14 days after receiving the influenza vaccine is described and the characteristics of influenza-associated cutaneous leukocytoclastic vasculitis in older individuals are reviewed.
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Affiliation(s)
- Stella X Chen
- School of Medicine, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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Chagury AA, Sennes LU, Gil JM, Kalil J, Rodrigues H, Rosales CB, Miziara ID. HLA-C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 Alleles Associated to Bullous Pemphigoid in Brazilian Population. Ann Dermatol 2017; 30:8-12. [PMID: 29386826 PMCID: PMC5762482 DOI: 10.5021/ad.2018.30.1.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 11/08/2022] Open
Abstract
Background Bullous pemphigoid (BP) is an autoimmune disease with bullous vesicles and an incidence of 0.2 to 1.4 per 100,000 inhabitants. Many studies have been published demonstrating the association of pemphigoid with HLA class II system alleles in different populations, however there are no data on the BP, one of the most heterogeneous in the world. Objective To typify HLA alleles in Brazilians with Bullous pemphigoid. Methods The study group included 17 Brazilian patients with a confirmed diagnosis of BP from a hospital in Sao Paulo city, southeast Brazil. DNA was extracted from peripheral blood using Qiagen kits and HLA A, B, C, DR and DQ typing was performed using polymerase chain reaction. The control group was composed of a database of 297 deceased donors from the city of Sao Paulo. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA class I (A, B and C) and class II (DRB1, DQB1 and DQA1). Results Our findings show that alleles HLA C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 are associated with the onset of the disease in the Brazilian population, with relative risks of 8.31 (2.46 to 28.16), 3.76 (1.81 to 7.79), 3.57 (1.53 to 8.33), and 4.02 (1.87 to 8.64), respectively (p<0.005). Conclusion Our data indicate that Brazilian patients with BP present the same genetic predisposition linked to HLA-DQB1*03:01 previously reported in Caucasian and Iranian individuals and our study introduces three new alleles (C*17, DQA1*01:03 and DQA1*05:05) involved in the pathophysiology of BP.
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Affiliation(s)
- Azis Arruda Chagury
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Luiz Ubirajara Sennes
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Julio Miranda Gil
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Jorge Kalil
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Helcio Rodrigues
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Claudia B Rosales
- Transplant Immunology and Immunogenetics Laboratory, Heart Institute (INCOR), School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
| | - Ivan Dieb Miziara
- ENT Department of Otorhinolaryngology, School of Medicine, Sao Paulo University, Sao Paulo City, Brazil
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Bhoopalan SV, Chawla V, Hogan MB, Wilson NW, Das SU. Bullous Skin Manifestations of Mycoplasma pneumoniae Infection: A Case Series. J Investig Med High Impact Case Rep 2017; 5:2324709617727759. [PMID: 28959692 PMCID: PMC5593211 DOI: 10.1177/2324709617727759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/26/2017] [Accepted: 07/16/2017] [Indexed: 12/02/2022] Open
Abstract
Bullous skin lesions are uncommon in children. While it is well known that Mycoplasma infections are associated with papular skin manifestations, bullous skin lesions are not commonly reported. Mycoplasma pneumoniae is a very common bacterial pathogen causing respiratory tract infection in children and adults. We report 2 children with serology-confirmed Mycoplasma infection who were hospitalized for blistering skin lesions. Both of our patients responded well to corticosteroids and one of them required intravenous immunoglobulin. The aim of this case report is to raise awareness that Mycoplasma pneumoniae infection can present with bullous skin lesions, and to briefly review the pathophysiology, diagnosis, and management of the skin manifestation of Mycoplasma infection.
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Affiliation(s)
| | - Vonita Chawla
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | | | - Nevin W Wilson
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | - Samrat U Das
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
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Abstract
Scabies, a parasitic infestation caused by the mite Sarcoptes scabiei, is diagnosed by observing either the mite, its ova, or its excrement. The mite tracts, known as burrows and a characteristic presentation of the pruritic condition, are typically found on the web spaces between the fingers. Other cutaneous lesions include excoriated papules, pustules, and vesicles. However, atypical clinical variants of scabies, such as bullous, crusted, hidden, incognito, nodular, and scalp forms of the parasitic infestation, mimic the morphologic features of other non-parasitic dermatoses. A 76-year-old man presented with pruritic blisters and urticarial plaques that demonstrated not only pathology changes, but direct immunofluorescence also showed findings of bullous pemphigoid. His condition improved, but did not resolve, with topical corticosteroid cream for the management of the primary autoimmune blistering disorder. When other family members subsequently developed scabies, the correct diagnosis for his condition, bullous scabies, was established by demonstrating mites, ova, and scybala on a mineral oil preparation from a skin scraping of a newly appearing burrow. Bullous scabies can masquerade not only clinically, but also both pathologically and immunologically as bullous pemphigoid. Scabies serrupticius is introduced as a unifying term to designate all of the non-classic presentations of S. scabiei mite infestation.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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Gornowicz-Porowska J, Seraszek-Jaros A, Bowszyc-Dmochowska M, Kaczmarek E, Pietkiewicz P, Bartkiewicz P, Dmochowski M. Accuracy of molecular diagnostics in pemphigus and bullous pemphigoid: comparison of commercial and modified mosaic indirect immunofluorescence tests as well as enzyme-linked immunosorbent assays. Postepy Dermatol Alergol 2017; 34:21-7. [PMID: 28261028 DOI: 10.5114/ada.2017.65617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/29/2015] [Indexed: 12/24/2022] Open
Abstract
Introduction Pemphigus and bullous pemphigoid (BP) are identified by autoantibodies (abs) against desmoglein 1, 3 (DSG1/3) and BP180/BP230, respectively. A novel mosaic to indirect immunofluorescence (IIF) using purified BP180 recombinant proteins spotted on slide and transfected cells expressing BP230, DSG1, DSG3 is available. The commercial (IgG detection) and modified (IgG4 detection) mosaic for indirect immunofluorescence (IIFc – IIF commercial, IIFm – IIF modified) and IgG ELISAs were evaluated in pemphigus and bullous pemphigoid (BP) molecular diagnostics. Aim To compare diagnostic accuracy of commercial (IgG detection) and modified (IgG4 detection) mosaic IIF assay and to examine the diagnostic value of ELISAs in relation to mosaic IIF in routine laboratory diagnostics of pemphigus and BP. Material and methods Sera from 37 BP and 19 pemphigus patients were studied. Associations between tests were assessed using Fisher’s exact test. Results There are associations between the positive/negative samples detected by IIFc with desmoglein1 (DSG1)/desmoglein3 (DSG3)/BP230 transfected cells and ELISAs and no association between anti-BP180 IgG detection by IIFc and ELISA. IIFm with DSG1 and DSG3 showed both 100% sensitivity and 100% and 78% specificity, respectively, and 100% and 83% positive predictive value in relation to IIFc. IIFm with BP230 had 87% specificity, 55% sensitivity, whereas IIFm with BP180 had a 100% sensitivity and 13% specificity in relation to IIFc. Conclusions The IIFc with DSG1/DSG3/BP230 transfected cells, excluding BP180 spots, is an alternative method to ELISA in pemphigus/BP diagnostics. IgG4 antibodies, both pathogenically and diagnostically important, are inconsistently detectable with IIFm.
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Bartkiewicz P, Gornowicz-Porowska J, Pietkiewicz PP, Świrkowicz A, Bowszyc-Dmochowska M, Dmochowski M. Neurodegenerative disorders, bullous pemphigoid and psoriasis: a comparative study in ethnic Poles indicates that Parkinson's disease is more relevant to bullous pemphigoid. Postepy Dermatol Alergol 2017; 34:42-46. [PMID: 28261030 PMCID: PMC5329105 DOI: 10.5114/ada.2017.65619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Bullous pemphigoid (BP) is an autoimmune blistering dermatosis of the elderly with autoimmunity to hemidesmosomal proteins, BP180 and BP230, which are expressed also in neuronal tissue. AIM The aim here was to retrospectively compare the prevalence of neurodegenerative disorders (ND), particularly Parkinson's disease (PD), unspecified conditions manifesting as dementia and stroke, in two groups of ethnic Poles, with BP and with psoriasis (Ps), in order to obtain data whether BP is more prone to coexist with ND than Ps in the elderly. Psoriasis was chosen in this comparative study as it was considered to be a paradigm of cutaneous disease with systemic manifestations. MATERIAL AND METHODS The available medical records of 96 BP patients and 149 Ps patients over 70 years of age were analyzed for the presence of ND. RESULTS There were no statistically significant differences in prevalence of ND without specifying the type and ND types analyzed between BP and Ps groups, except for a higher prevalence of PD in the BP group. CONCLUSIONS Thus, regarding population aging and increasing incidence and prevalence of BP corresponding with that phenomenon in various ethnicities, it appears justified to expand studies of a possible immunopathogenic relationship, appearing to be PD-related, between BP and ND.
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Affiliation(s)
- Paweł Bartkiewicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Justyna Gornowicz-Porowska
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł P. Pietkiewicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Świrkowicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Cutaneous Histopathology and Immunopathology Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
Fixed drug eruption (FDE) is a common type of drug eruption seen in skin clinics. It is characterized by solitary or multiple, round to oval erythematous patches with dusky red centers, some of which may progress to bulla formation. Bullous FDE may be caused by a number of drugs. We hereby describe a case of azithromycin-induced bullous FDE; to the best of our knowledge, this is the first such case being reported.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Karan Sancheti
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Indrashis Podder
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Nilay Kanti Das
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
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Affiliation(s)
- Annie Ferguson
- Dermatology Department, the Oregon Health and Science University, Portland, Oregon
| | - Spring Golden
- Dermatology Department, the Oregon Health and Science University, Portland, Oregon
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Affiliation(s)
| | | | - Robert T. Gilson
- Division of Dermatology and Cutaneous Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
- Correspondence to: Robert T. Gilson, MD, Associate Professor, Division of Dermatology and Cutaneous Surgery, 7979 Wurzbach Road, Grossman Building, 3rd Floor, Mail Code 7876, San Antonio, TX 78229-4427.
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Abstract
Heparin is one of the most widely prescribed medications. Cutaneous reactions distant to the injection site are rare and under-reported in the literature. We present an elderly man with history of CNS lymphoma who underwent treatment of a deep venous thrombosis with enoxaparin and subsequently developed well demarcated bullous lesions within days of heparin initiation. The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. The handful of cases thus far suggest that regression of these seemingly benign lesions may or may not be associated with dose reduction or discontinuation of heparin products and typically occur within a few weeks. Elderly age appears to be one potential risk factor for development of these rare asymptomatic lesions. Malignancy may have some contributing factor and differentiation between this rare cutaneous manifestation from heparin products and other dermatological findings in patients with malignancy is key. Because of the asymptomatic and self-limiting nature of hemorrhagic bullous dermatoses in the setting of heparin product use, we presume that the reported incidence does not reflect true clinical practice.
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Affiliation(s)
- Bhuvanesh Govind
- a Department of Neurology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Esteban Gnass
- b Department of Pathology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Geno Merli
- c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Luis Eraso
- c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
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Zhou XP, Liu B, Xu Q, Yang Y, He CX, Zuo YG, Liu YH. Serum levels of immunoglobulins G1 and G4 targeting the non-collagenous 16A domain of BP180 reflect bullous pemphigoid activity and predict bad prognosis. J Dermatol 2016; 43:141-8. [PMID: 26300465 DOI: 10.1111/1346-8138.13051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/24/2015] [Indexed: 01/26/2023]
Abstract
Bullous pemphigoid (BP) is an autoimmune subepidermal bullous disease, and different immunoglobulin (Ig)G autoantibody subclasses may play different roles in the pathogenesis of BP. This study aims to evaluate the relationship between specific IgG subclasses and BP. Enzyme-linked immunoassays (ELISA) were developed to test the IgG subclasses targeting the non-collagenous 16A (NC16A) domain of BP180. A statistical analysis was carried out to assess the relationship of BP and IgG subclasses as well as other factors. The correlation coefficients between the ELISA scores for four IgG subclasses and disease severity scores were 0.586 for IgG, 0.441 for IgG1, 0.594 for IgG2, 0.345 for IgG3, and 0.448 for IgG4 before treatment. After treatment, the correlation coefficient was 0.376 for IgG, 0.522 for IgG1, 0.314 for IgG2, 0.582 for IgG3 and 0.503 for IgG4. Spearman's rank correlation coefficient was 0.801 for IgG1, 0.66 for IgG2, 0.575 for IgG3 and 0.463 for IgG4 between the ELISA scores of IgG subclasses and the disease severity score variation. The ELISA scores of IgG subclasses in patients with mucosal involvement were higher than those without. Survival analysis showed that sex, IgG1 and IgG4 were the independent predictors for BP. In conclusion, the serum levels of IgG1 and IgG4 targeting BP180NC16A were paralleled with disease severity in BP patients. IgG1 and IgG4 and sex were the independent prognostic factors for an early prognosis of BP.
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Affiliation(s)
- Xi-Ping Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Xia He
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Gang Zuo
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Hua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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