Subepidermal autoimmune bullous diseases （SABD） are some autoimmune skin diseases that can present in a variety of forms and can be a challenging disease to treat. An overview of the different forms of SABD are disc...Subepidermal autoimmune bullous diseases （SABD） are some autoimmune skin diseases that can present in a variety of forms and can be a challenging disease to treat. An overview of the different forms of SABD are discussed including bullous pemphigoid （BP）, epidermolysis bullosa acquisita （EBA）, cicatricial pemphigoid （CP）, bullous systemic lupus erythematosus （BSLE）, and Anti-p200 pemphigoid. Emphasis on recent advancement is presented. In recent years, improved knowledge of the mechanisms of intercellular and cell-matrix adhesion has led to better understanding of the blistering process in some SABD. Defects of such structures cause the subepidermal bullous diseases and have also led to the discovery of new diseases （e.g. anti-p200-pemphigoid）. Recent studies have outlined the important role of autoantibodies, mast cell lymphocytes and their cytokines in pathogenesis of SABD.展开更多
Objective: To determine the occurrence of oral manifestations, gingival index, dental state and associated therapeutic aspects in patients with vesiculobullous diseases. Study design: Prospective and observational stu...Objective: To determine the occurrence of oral manifestations, gingival index, dental state and associated therapeutic aspects in patients with vesiculobullous diseases. Study design: Prospective and observational study conducted with 69 patients from May 2013 to May 2014 at the Dermatology Outpatient Clinic of the Clinical Hospital, University of São Paulo Medical School, Brazil. Data were analyzed for frequency in absolute values, percentage and correlation using the Chi-square test. Results: 84.1% of the patients had oral manifestations of vesiculobullous diseases (p = 0.001);25% had gingival lesions;18.2% had lesions in the buccal mucosa, and 17.6% in the lips, with no correlation between the location and the type of disease (p = 0.990). Among all patients with bullous pemphigoid, linear IgA dermatosis, and mucous membrane pemphigoid, 59 (93.6%) patients had gingival inflammation of dental origin but without significant correlation (p = 0.42). There was correlation between pemphigus vulgaris and periodontal disease (p = 0.05). Conclusion: Gingival inflammation seems to interfere negatively with the clinical course of these diseases. Further studies should be conducted to better clarify the interrelations between dental and gingival state, and between vesiculobullous diseases and oral involvement.展开更多
Objective:To investigate the clinical efficacy of plasma exchange therapy for autoimmune bullous skin disease.Methods:Fifty patients with autoimmune bullous skin disease enrolled in our hospital from January 2018 to J...Objective:To investigate the clinical efficacy of plasma exchange therapy for autoimmune bullous skin disease.Methods:Fifty patients with autoimmune bullous skin disease enrolled in our hospital from January 2018 to January 2019 were selected.The patients were grouped by treatment method:25 control group patients were given conventional hormone therapy,while 25 experimental group patients were treated with plasma exchange therapy;efficacy of treatment was compared between two groups of patients.Results:Initial dose,maximum dose,and cumulative dose of glucocorticoids were lower in experimental group patients than those in control group(P<0.05).Incidence of complication was lower in experimental group patients than those in control group(P<0.05);the difference was significant.There was no significant difference in short-term efficacy between the two groups(P>0.05).Conclusion:The application of plasma exchange therapy was effective for treatment of autoimmune bullous skin disease.It could reduce dosage amount of glucocorticoids and incidence of complications;its application can be promoted.展开更多
Background: Idiopathic Bullous Pemphigoid (IBP) is a rare blistering autoimmune disease. Its morbidity and mortality have remained high owing to complications of extensive skin involvement as well as its conventional ...Background: Idiopathic Bullous Pemphigoid (IBP) is a rare blistering autoimmune disease. Its morbidity and mortality have remained high owing to complications of extensive skin involvement as well as its conventional steroid therapy. We reviewed the medical literature and found indicators of an autoimmune etiology for its pathogenesis triggering genetically predisposed patients. Objective: to evaluate, prospectively, the role of Rituximab (R) therapy in its persistent, severe and extensive form. Patients and methods: A total of 12 patients, with disease duration of 6 ± 1 months, were treated with yearly R infusions (1 g followed by 1 g 2 weeks later). Results: Significant clinical improvement was achieved as documented by decrease in total score of Bullous Pemphigoid Disease Area Index from 60 ± 3 to 6 ± 2 that persisted for 26 ± 11 months of follow up. Moreover, IBP autoantibodies (anti-BP 180 and anti-320 IgG) levels fell from to 91 ± 3 and 81 ± 2 to 8 ± 2 and 9 ± 2, respectively. Conclusions: R is a safe and effective treatment for severe IBP and such response further confirms its autoimmune pathogenesis.展开更多
The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included i...The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.展开更多
Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it...Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it regulates several important physiological functions.DPP-4 regulates several immune functions,including T-cell activation,macrophage function,and secretion of cytokines.Studies have reported an increase in autoimmune diseases like bullous pemphigoid,inflammatory bowel disease,and arthritis with DPP-4i use.The relationship of DPP-4i and autoimmune diseases is a complex one and warrants further research into the effect of DPP-4 inhibition on the immune system to understand the pathogenesis more clearly.Whether a particular cluster of autoimmune diseases is associated with DPP-4i use remains an important contentious issue.Nevertheless,a heightened awareness from the clinicians is required to identify and treat any such diseases.Through this review,we explore the clinical and pathophysiological characteristics of this association in light of recent evidence.展开更多
Introduction:Numerous dermatoses associated with monoclonal gammopathy have been reported in the literature.Subepidermal autoimmune bullous diseases(SABD)are one of them which were not common.Case presentation:A 68-ye...Introduction:Numerous dermatoses associated with monoclonal gammopathy have been reported in the literature.Subepidermal autoimmune bullous diseases(SABD)are one of them which were not common.Case presentation:A 68-year-old male patient was admitted to our clinic with erosions on the oral mucosa,tense blisters,erosions,and ulcers on the trunk and extremities.Subepidermal vesicle formation was detected in the skin biopsy.Clinical examination revealed positivity for the Nikolsky phenomenon.The disease was unresponsive to conventional treatments and dysphagia and hoarseness occurred.The patient was screened for malignancy due to his unresponsiveness to the treatments and his severe oral mucosal involvement.Ig-G MGUS was detected in the patient.Discussion:The Nikolsky sign is an indicator of acantholysis and is known as a specific finding for pemphigus.However,when we look at gammopathy-associated autoimmune bullous dermatoses,skin fragility has been reported in cases.However,the meaning of fragility is not explained.The diagnosis of all these patients was Ig-M MGUS.Our patient was presented because of non-IgM MGUS,direct Nikolsky positivity,and severe mucosal involvement.Conclusion:Nikolsky positivity may be a clue for gammopathy-related subepidermal autoimmune bullous diseases.展开更多
文摘Subepidermal autoimmune bullous diseases （SABD） are some autoimmune skin diseases that can present in a variety of forms and can be a challenging disease to treat. An overview of the different forms of SABD are discussed including bullous pemphigoid （BP）, epidermolysis bullosa acquisita （EBA）, cicatricial pemphigoid （CP）, bullous systemic lupus erythematosus （BSLE）, and Anti-p200 pemphigoid. Emphasis on recent advancement is presented. In recent years, improved knowledge of the mechanisms of intercellular and cell-matrix adhesion has led to better understanding of the blistering process in some SABD. Defects of such structures cause the subepidermal bullous diseases and have also led to the discovery of new diseases （e.g. anti-p200-pemphigoid）. Recent studies have outlined the important role of autoantibodies, mast cell lymphocytes and their cytokines in pathogenesis of SABD.
文摘Objective: To determine the occurrence of oral manifestations, gingival index, dental state and associated therapeutic aspects in patients with vesiculobullous diseases. Study design: Prospective and observational study conducted with 69 patients from May 2013 to May 2014 at the Dermatology Outpatient Clinic of the Clinical Hospital, University of São Paulo Medical School, Brazil. Data were analyzed for frequency in absolute values, percentage and correlation using the Chi-square test. Results: 84.1% of the patients had oral manifestations of vesiculobullous diseases (p = 0.001);25% had gingival lesions;18.2% had lesions in the buccal mucosa, and 17.6% in the lips, with no correlation between the location and the type of disease (p = 0.990). Among all patients with bullous pemphigoid, linear IgA dermatosis, and mucous membrane pemphigoid, 59 (93.6%) patients had gingival inflammation of dental origin but without significant correlation (p = 0.42). There was correlation between pemphigus vulgaris and periodontal disease (p = 0.05). Conclusion: Gingival inflammation seems to interfere negatively with the clinical course of these diseases. Further studies should be conducted to better clarify the interrelations between dental and gingival state, and between vesiculobullous diseases and oral involvement.
文摘Objective:To investigate the clinical efficacy of plasma exchange therapy for autoimmune bullous skin disease.Methods:Fifty patients with autoimmune bullous skin disease enrolled in our hospital from January 2018 to January 2019 were selected.The patients were grouped by treatment method:25 control group patients were given conventional hormone therapy,while 25 experimental group patients were treated with plasma exchange therapy;efficacy of treatment was compared between two groups of patients.Results:Initial dose,maximum dose,and cumulative dose of glucocorticoids were lower in experimental group patients than those in control group(P<0.05).Incidence of complication was lower in experimental group patients than those in control group(P<0.05);the difference was significant.There was no significant difference in short-term efficacy between the two groups(P>0.05).Conclusion:The application of plasma exchange therapy was effective for treatment of autoimmune bullous skin disease.It could reduce dosage amount of glucocorticoids and incidence of complications;its application can be promoted.
文摘Background: Idiopathic Bullous Pemphigoid (IBP) is a rare blistering autoimmune disease. Its morbidity and mortality have remained high owing to complications of extensive skin involvement as well as its conventional steroid therapy. We reviewed the medical literature and found indicators of an autoimmune etiology for its pathogenesis triggering genetically predisposed patients. Objective: to evaluate, prospectively, the role of Rituximab (R) therapy in its persistent, severe and extensive form. Patients and methods: A total of 12 patients, with disease duration of 6 ± 1 months, were treated with yearly R infusions (1 g followed by 1 g 2 weeks later). Results: Significant clinical improvement was achieved as documented by decrease in total score of Bullous Pemphigoid Disease Area Index from 60 ± 3 to 6 ± 2 that persisted for 26 ± 11 months of follow up. Moreover, IBP autoantibodies (anti-BP 180 and anti-320 IgG) levels fell from to 91 ± 3 and 81 ± 2 to 8 ± 2 and 9 ± 2, respectively. Conclusions: R is a safe and effective treatment for severe IBP and such response further confirms its autoimmune pathogenesis.
文摘The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.
文摘Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it regulates several important physiological functions.DPP-4 regulates several immune functions,including T-cell activation,macrophage function,and secretion of cytokines.Studies have reported an increase in autoimmune diseases like bullous pemphigoid,inflammatory bowel disease,and arthritis with DPP-4i use.The relationship of DPP-4i and autoimmune diseases is a complex one and warrants further research into the effect of DPP-4 inhibition on the immune system to understand the pathogenesis more clearly.Whether a particular cluster of autoimmune diseases is associated with DPP-4i use remains an important contentious issue.Nevertheless,a heightened awareness from the clinicians is required to identify and treat any such diseases.Through this review,we explore the clinical and pathophysiological characteristics of this association in light of recent evidence.
文摘Introduction:Numerous dermatoses associated with monoclonal gammopathy have been reported in the literature.Subepidermal autoimmune bullous diseases(SABD)are one of them which were not common.Case presentation:A 68-year-old male patient was admitted to our clinic with erosions on the oral mucosa,tense blisters,erosions,and ulcers on the trunk and extremities.Subepidermal vesicle formation was detected in the skin biopsy.Clinical examination revealed positivity for the Nikolsky phenomenon.The disease was unresponsive to conventional treatments and dysphagia and hoarseness occurred.The patient was screened for malignancy due to his unresponsiveness to the treatments and his severe oral mucosal involvement.Ig-G MGUS was detected in the patient.Discussion:The Nikolsky sign is an indicator of acantholysis and is known as a specific finding for pemphigus.However,when we look at gammopathy-associated autoimmune bullous dermatoses,skin fragility has been reported in cases.However,the meaning of fragility is not explained.The diagnosis of all these patients was Ig-M MGUS.Our patient was presented because of non-IgM MGUS,direct Nikolsky positivity,and severe mucosal involvement.Conclusion:Nikolsky positivity may be a clue for gammopathy-related subepidermal autoimmune bullous diseases.
