Early Description of Diet-Induced Blistering Skin Diseases in Medieval Persia: Avicenna's Point of View

Pemphigus is an autoimmune blistering skin disease that is strongly associated with different environmental factors. Among these, nutritional factors are considered to trigger pemphigus; however, their role may be underestimated. Investigated more recently in conventional medicine, this causative bond between dietary factors and blistering skin diseases was mentioned by Persian scholars such as Avicenna a thousand years ago. Avicenna, a well-known Persian physician and philosopher, who could be considered a pioneer in dermatology, discussed skin diseases in a chapter in The Canon of Medicine. He accounted for some nutritional triggers for skin blisters (mentioned as "hot swellings"), such as onion, garlic, leek, pepper, and wine. His precise description of causative factors based on principles of traditional Persian medicine (TPM) is appreciable and might well lead us to find more efficient ways for the prevention and treatment of blistering skin diseases.

[Nikolsky and his sign]

Piotr Vasiliyevich Nikolsky (1858-1940) trained as a dermatologist and venereologist in Kiev. In 1898 he was appointed to the chair at the University of Warsaw, which moved to Rostov on the Don during the First World War. In his doctoral dissertation of 1896 he described the sign now named after him; in patients with pemphigus foliaceus, gentle rubbing of the skin causes crinkling because the superficial layer (stratum corneum) slides over the deeper layer. The same phenomenon was soon found in patients with pemphigus vulgaris, which is more common. The sign is absent in about 60% of patients with these conditions. It is also absent in patients with pemphigoid diseases, because in these patients it is the splitting of deeper layers of the skin that causes blistering.

The men behind the eponym: Francis E. Senear, Barney Usher, and the Senear-Usher syndrome

This historical review will summarize the report of Francis Senear and Barney Usher on a disease that they called pemphigus erythematodes and which later became pemphigus erythematosus (the Senear-Usher syndrome). It will then outline the lives of these two men. Finally, it will review the literature on that condition and relate the views of various authorities as to whether pemphigus erythematosus is merely pemphigus foliaceus, a variant of pemphigus foliaceus, a syndrome combining features of lupus erythematosus and pemphigus or whether pemphigus erythematosus (Senear-Usher syndrome) is a distinct and separate disease.

History of the establishment and revision of diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan

We summarize the process of establishing and revising the diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan (including the results of a nationwide survey regarding these guidelines). We also summarize the content and present an evaluation of the utility of these guidelines. Due to the publication of these documents throughout the Japanese medical community, it appears that patients with pemphigus have recently begun to receive appropriate treatment, dramatically improving their quality of life and prognosis. Continuous examination of these criteria by means of follow-up studies of patients treated according to the guidelines is necessary to determine the long-term efficacy of treatment. To this end, it is hoped that these guidelines will be more extensively disseminated among the medical community.

[Pemphigus vegetans. A historical perspective]

Pemphigus vegetans is a rare variant of pemphigus which is mainly localized in the intertriginous areas (Neumann type, Hallopeau type) or primarily involves the mucous membranes (pyostomatitis vegetans). A 18-year-old patient with erosive stomatitis developed a vegetating plaque with papillomatous and verruciform features in her left axilla. Histopathological examination of the axilla revealed papillomatosis and acanthosis as well as suprabasal clefting with acantholytic cells. By direct immunofluorescent examination, deposits of immunoglobulin IgG and complement (C3) were found in the intercellular space of the epidermis. Serological examination by indirect immunofluorescent techniques was indicative of pemphigus autoantibodies at a titer of 1:40. This case report demonstrates that the classical differentiation of pemphigus vegetans in two types, Neumann type and Hallopeau type, is mainly of historical importance, because both entities may represent variants of the same disease. In addition, other disorders such as IgA pemphigus may also present with vegetating plaques in intertriginous sites.

Endemic pemphigus foliaceus (Fogo Selvagem): II. Current and historic epidemiologic studies

This paper details current and historic epidemiologic features of Fogo Selvagem (Endemic pemphigus foliaceus) in Brazil. The following features are described. a) The disease occurs in endemic fashion in regions of Brazil within the states of Goias, Mato Grosso do Sul, Parana, Sao Paulo, and Minas Gerais. It appears that the disease is spreading toward the northwest and west, involving the states of Mato Grosso, Para, Maranhao, Rondonia, Acre, and Amazonas. b) People at risk are young peasants or children of either sex or any race exposed to the local ecology in rural areas of endemic states. Although the disease has been described in urban centers, these occurrences are rare. c) Fogo Selvagem commonly appears in wild areas being colonized and disappears as these areas become urbanized. d) The majority of patients live in close proximity to rivers and within the 10-15 Km flying range of mosquitos or black flies (such as Simulium). It is hypothesized that a black fly, Simulium pruinosum may be the vector that precipitates the disease. f) There is a significant number of Fogo Selvagem in family units where multiple, genetically related individuals are affected. g) Finally, autoantibodies against lupus-associated antigens are not present in the sera of patients with Fogo Selvagem. Clinical examination of the skin, and serologic screening for pemphigus autoantibodies are specific parameters that can be used in the search for the etiologic agents that lead to autoimmune disease of the skin. To identify and prove an etiologic agent for this well-characterized autoimmune disease would be of tremendous importance to the understanding of autoimmune skin diseases, and potentially other organ-specific autoimmune disorders.