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Autoimmune Bullous Diseases

Braun-Falco´s Dermatology

Abstract

Bullous autoimmune dermatoses are the result of an autoantibody-driven immune response against structural proteins of the skin. The cause of autoantibody formation is largely unknown. Three disease groups of bullous autoimmune dermatoses are distinguished, which differ clearly in pathogenesis and clinical picture, although they all typically manifest themselves with inflammatory blisters of the skin: Pemphigus and pemphigoid diseases as well as dermatitis herpertiformis Duhring. In pemphigus diseases, autoantibodies are formed against desmosomal adhesion proteins that mediate epidermal cell-cell contact. This leads to intraepidermal blister formation. In contrast, in pemphigoid diseases the blisters are subepidermal and are caused by autoantibodies against hemidesmosomal structural proteins or anchoring fibrils of the dermo-epidermal junction zone with subsequent recruitment of granulocytes into the skin.

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References

Pemphigus Diseases

  • Ahmed AR, Spigelman Z, Cavacini LA et al (2006) Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin. N Engl J Med 355:1772–1779

    CAS  PubMed  Google Scholar 

  • Amagai M, Klaus-Kovtun V, Stanley JR (1991) Autoantibodies against a novel epithelial cadherin in pemphigus vulgaris, a disease of cell adhesion. Cell 67:869–877

    CAS  PubMed  Google Scholar 

  • Amagai M, Tsunoda K, Zillikens D et al (1999) The clinical phenotype of pemphigus is defined by the anti-desmoglein autoantibody profile. J Am Acad Dermatol 40:167–170

    CAS  PubMed  Google Scholar 

  • Amagai M, Ahmed AR, Kitajima Y et al (2006) Are desmoglein autoantibodies essential for the immunopathogenesis of pemphigus vulgaris, or just “witnesses of disease”. Exp Dermatol 15:815–831

    CAS  PubMed  Google Scholar 

  • Amagai M, Ikeda S, Shimizu H et al (2009) A randomized double-blind trial of intravenous immunoglobulin for pemphigus. J Am Acad Dermatol 60:595–603

    PubMed  Google Scholar 

  • Anhalt GJ, Labib RS, Voorhees JJ et al (1982) Induction of pemphigus in neonatal mice by passive transfer of IgG from patients with the disease. N Engl J Med 306:1189–1196

    CAS  PubMed  Google Scholar 

  • Chams-Davatchi C, Esmaili N, Daneshpazhooh M et al (2007) Randomized controlled open-label trial of four treatment regimens for pemphigus vulgaris. J Am Acad Dermatol 57:622–628

    PubMed  Google Scholar 

  • Chan LS, Vanderlugt CJ, Hashimoto T et al (1998) Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol 110:103–109

    CAS  PubMed  Google Scholar 

  • Diaz LA, Sampaio SA, Rivitti EA et al (1989) Endemic pemphigus foliaceus (fogo selvagem). I. Clinical features and immunopathology. J Am Acad Dermatol 20:657–669

    CAS  PubMed  Google Scholar 

  • Gelding D (1992) Intraepidermal IgA pustulosis. J Am Acad Dermatol 27:993–1000

    Google Scholar 

  • Hashimoto T, Kiyokawa C, Mori O et al (1997) Human desmocollin 1 (Dsc1) is an autoantigen for the subcorneal pustular dermatosis type of IgA pemphigus. J Invest Dermatol 109:127–131

    CAS  PubMed  Google Scholar 

  • Hertl M, Eming R, Veldman C (2006) T cell control in autoimmune bullous skin disorders. J Clin Invest 116:1159–1166

    CAS  PubMed  PubMed Central  Google Scholar 

  • Hertl M, Jedlickova H, Karpati S et al (2015) Pemphigus. S2 guideline for diagnosis and treatment – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 29:405–414

    CAS  PubMed  Google Scholar 

  • Jolly PS, Berkowitz P, Bektas M et al (2010) p38 MAPK signaling and desmoglein-3 internalization are linked events in pemphigus acantholysis. J Biol Chem 285:8936–8941

    CAS  PubMed  PubMed Central  Google Scholar 

  • Joly P, Mouquet H, Roujeau JC et al (2007) A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med 357:545–552

    CAS  PubMed  Google Scholar 

  • Nguyen VT, Ndoye A, Shultz LD et al (2000) Antibodies against keratinocyte antigens other than desmogleins 1 and 3 can induce pemphigus vulgaris-like lesions. J Clin Invest 106:1467–1479

    CAS  PubMed  PubMed Central  Google Scholar 

  • Pfutze M, Niedermeier A, Hertl M et al (2007) Introducing a novel Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) in pemphigus. Eur J Dermatol 17:4–11

    PubMed  Google Scholar 

  • Rosenbach M, Murrell DF, Bystryn JC et al (2009) Reliability and convergent validity of two outcome instruments for pemphigus. J Invest Dermatol 129:2404–2410

    CAS  PubMed  PubMed Central  Google Scholar 

  • Stanley JR, Amagai M (2006) Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med 355:1800–1810

    CAS  PubMed  Google Scholar 

  • Zillikens D, Derfler K, Dormann D et al (2007) Recommendations for the use of immunoapheresis in the treatment of autoimmune bullous dermatosis. J German Dermatol Ges 5:881–888

    Google Scholar 

Pemphigoid Diseases

  • Chan LS, Ahmed AR, Anhalt GJ et al (2002) The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol 138:370–379

    PubMed  Google Scholar 

  • Dilling A, Rose C, Hashimoto T et al (2007) Anti-p200 pemphigoid: a novel autoimmune subepidermal blistering disease. J Dermatol 34:1–8

    PubMed  Google Scholar 

  • Foster CS (1986) Cicatricial pemphigoid. Trans Am Ophthalmol Soc 84:527–663

    CAS  PubMed  PubMed Central  Google Scholar 

  • Gammon WR, Briggaman RA, Woodley DT et al (1984) Epidermolysis bullosa acquisita – a pemphigoid-like disease. J Am Acad Dermatol 11:820–832

    CAS  PubMed  Google Scholar 

  • Gammon WR, Woodley DT, Dole KC et al (1985) Evidence that anti-basement membrane zone antibodies in bullous eruption of systemic lupus erythematosus recognize epidermolysis bullosa acquisita autoantigen. J Invest Dermatol 84:472–476

    CAS  PubMed  Google Scholar 

  • Hübner F, Recke A, Zillikens D et al (2016) Prevalence and age distribution of pemphigus and pemphigoid diseases. J Invest Dermatol 136:2495–2498. S0022-202X:32122-32124

    PubMed  Google Scholar 

  • Joly P, Roujeau JC, Benichou J et al (2002) A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 346:321–327

    CAS  PubMed  Google Scholar 

  • Khumalo NP, Murrell DF, Wojnarowska F et al (2002) A systematic review of treatments for bullous pemphigoid. Arch Dermatol 138:385–389

    PubMed  Google Scholar 

  • Kirtschig G, Murrell D, Wojnarowska F et al (2002) Interventions for mucous membrane pemphigoid/cicatricial pemphigoid and epidermolysis bullosa acquisita: a systematic literature review. Arch Dermatol 138:380–384

    PubMed  Google Scholar 

  • Nishie W, Sawamura D, Goto M et al (2007) Humanization of autoantigen. Nat Med 13:378–383

    CAS  PubMed  Google Scholar 

  • Rzany B, Partscht K, Jung M et al (2002) Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticosteroids, and old age. Arch Dermatol 138:903–908

    PubMed  Google Scholar 

  • Schmidt E, Zillikens D (2013) Pemphigoid diseases. Lancet 26:320–332

    Google Scholar 

  • Schmidt E, Obe K, Brocker EB et al (2000) Serum levels of autoantibodies to BP180 correlate with disease activity in patients with bullous pemphigoid. Arch Dermatol 136:174–178

    CAS  PubMed  Google Scholar 

  • Setterfield J, Shirlaw PJ, Kerr-Muir M et al (1998) Mucous membrane pemphigoid: a dual circulating antibody response with IgG and IgA signifies a more severe and persistent disease. Br J Dermatol 138:602–610

    CAS  PubMed  Google Scholar 

  • Vodegel RM, Jonkman MF, Pas HH, de Jong MC (2004) U-serrated immunodeposition pattern differentiates type VII collagen targeting bullous diseases from other subepidermal bullous autoimmune diseases. Br J Dermatol 151:112–118

    CAS  PubMed  Google Scholar 

  • Woodley DT, Briggaman RA, O'Keefe EJ et al (1984) Identification of the skin basement membrane autoantigen in epidermolysis bullosa acquisita. N Engl J Med 310:1007–1013

    CAS  PubMed  Google Scholar 

  • Zillikens D, Mascaro JM, Rose PA et al (1997) A highly sensitive enzyme-linked immunosorbent assay for the detection of circulating anti-BP180 autoantibodies in patients with bullous pemphigoid. J Invest Dermatol 109:679–683

    CAS  PubMed  Google Scholar 

  • Zone JJ, Taylor TB, Meyer LJ et al (1998) The 97 kDa linear IgA bullous disease antigen is identical to a portion of the extracellular domain of the 180 kDa bullous pemphigoid antigen, BPAg2. J Invest Dermatol 110:207–210

    CAS  PubMed  Google Scholar 

Dermatitis Herpetiformis

  • Albers LN et al (2017) Retuximab treatment for recalcitrant dermatitis herpetiformis. JAMA Dermatol 153:315–318

    PubMed  Google Scholar 

  • Dieterich W, Laag E, Bruckner-Tuderman L et al (1999) Antibodies to tissue transglutaminase as serologic markers in patients with dermatitis herpetiformis. J Invest Dermatol 113:133–136

    CAS  PubMed  Google Scholar 

  • Green PH, Cellier C (2007) Celiac disease. N Engl J Med 357:1731–1743

    CAS  PubMed  Google Scholar 

  • Sardy M, Karpati S, Merkl B et al (2002) Epidermal transglutaminase (TGase 3) is the autoantigen of dermatitis herpetiformis. J Exp Med 195:747–757

    CAS  PubMed  PubMed Central  Google Scholar 

  • Sigurgeirsson B, Agnarsson BA, Lindelof B (1994) Risk of lymphoma in patients with dermatitis herpetiformis. BMJ 308:13–15

    CAS  PubMed  PubMed Central  Google Scholar 

First Describer

  • Anhalt GJ, Kim S, Stanley JR (1990) Paraneoplastic pemphigus: an autoimmune mucocutaneous disease associated with neoplasia. N Engl J Med 323:1729–1735

    CAS  PubMed  Google Scholar 

  • Asboe-Hansen G (1970) Diagnosis of pemphigus. Br J Dermatol 83(Suppl):81–92

    Google Scholar 

  • Bean SF, Michel B, Furey N et al (1976) Vesicular pemphigoid. Arch Dermatol 112:1402–1404

    CAS  PubMed  Google Scholar 

  • Beutner EH, Jordon RE (1964) Demonstration of skin antibodies in sera of pemphigus vulgaris patients by indirect immunofluorescence staining. Proc Soc Exp Biol Med 117:505–510

    CAS  PubMed  Google Scholar 

  • Brunsting LA, Perry HO (1957) Benign pemphigoid? A report of seven cases with chronic, scarring herpetiform plaques about the head and neck. Arch Dermatol 75:489–501

    CAS  Google Scholar 

  • Bunel JBH (1811) Essai sur le pemphigus. Thèse de médecine de Paris no. 103

    Google Scholar 

  • Cazenave P (1844) Pemphigus chronique, general; forme rare de pemphigus foliace; mort; autopsy; alteration du foie. Ann Mal Peau Syph 1:208–210

    Google Scholar 

  • Chorzelski TP, Jablonska S (1979) IgA linear dermatosis of childhood (chronic bullous disease of childhood). Br J Dermatol 101:535–542

    CAS  PubMed  Google Scholar 

  • Cottini GB (1955) Dermatite herpetiforme de Duhring symetrique et localise aux genome et aux condes. Ann Dermatol Syph 82:285–286

    CAS  Google Scholar 

  • Duhring LA (1884) Dermatitis herpetiformis. J Am Med Assoc 3:225–229

    Google Scholar 

  • Eberhartinger C, Niebauer G (1961) Zur Prognose und Therapie des Pemphigus vulgaris und ähnlicher Erkrankungen. Hautarzt 12:503–508

    CAS  PubMed  Google Scholar 

  • Gammon WR, Briggaman RA (1993) Epidermolysis bullosa acquisita and bullous systemic lupus erythematosus. Diseases of autoimmunity to type VII collagen. Dermatol Clin 11:535–547

    CAS  PubMed  Google Scholar 

  • Gelding D, Foldès C, Cottenot F (1982) Pustulose sous-cornée, acantholyse superficielle et IgA monoclonale. Ann Dermatol Venereol 109:959–963

    Google Scholar 

  • Hallopeau H (1889) Sur une nouvelle formme de dermatite pustuleuse chronique en foyers a progression excentrique. In: Congrès International de Dermatologie et de Syphiligraphie tenu à Paris (le session). Masson, Paris, pp 344–362

    Google Scholar 

  • Huff JC, Golitz LE, Kunke KS (1985) Intraepidermal neutrophilic IgA dermatosis. N Engl J Med 313:1643–1645

    CAS  PubMed  Google Scholar 

  • Jablonska S, Chorzelski TP, Beutner EH et al (1975) Herpetiform pemphigus, a variable pattern of pemphigus. Int J Dermatol 14:353–359

    CAS  PubMed  Google Scholar 

  • Jordon RE, Beutner EH, Witebsky E et al (1967) Basement membrane antibodies in bullous pemphigoid. JAMA 200:751–756

    CAS  PubMed  Google Scholar 

  • Kaposi M (1892) Lichen ruber mit diffusen Erythemen und pemphigusartigen Blasen (am 25. November 1891 der Wiener Dermatologischen Geselleschaft demonstrirt (sic). Arch Dermatol Syph 24:344

    Google Scholar 

  • Lever WF (1953) Pemphigus. Medicine 32:1–123

    CAS  PubMed  Google Scholar 

  • Levine N, Freilich A, Barland P (1979) Localized pemphigoid simulating dyshidrosiform dermatitis. Arch Dermatol 115:320–321

    CAS  PubMed  Google Scholar 

  • Milton J (1872) The pathology and treatment of diseases of the skin. Hardwicke, London, pp 205–209

    Google Scholar 

  • Neumann I (1886) Ueber Pemphigus vegetans (frambosioides) (Hierzu die Tafeln VI, VII, VIII u. IX). Arch Dermatol Syph 18:157–178

    Google Scholar 

  • Nikolsky PV (1896) Contribution à la question du pemphigus foliacé de Cazenave. Doctoral thesis, Kiev

    Google Scholar 

  • Roenigk HH, Ryan JG, Bergfield WF (1971) Epidermolysis bullosa acquisita. Arch Dermatol 103(1):10

    Google Scholar 

  • Schnyder U (1969) Pemphigoide séborrhéique. Entité nosologique nouvelle? Bull Soc Fr Derm Syph 76:320

    CAS  PubMed  Google Scholar 

  • Senear FE, Usher B (1926) An unusual type of pemphigus. Arch Dermatol 13:761–781

    Google Scholar 

  • Vieira JP (1940) Pemphigus foliaceus (fogo selvagem). Arch Dermatol 41:858–863

    Google Scholar 

  • Wichman JE (1791) Beytrag zur Kenntnis des Pemphigus. Keyser, Erfurt

    Google Scholar 

  • Winkelmann RK, Su WPD (1979) Pemphigoid vegetans. Arch Dermatol 115:446–448

    CAS  PubMed  Google Scholar 

  • Yung CW, Soltani K, Lorincz AL (1981) Pemphigoid nodularis. J Am Acad Dermatol 5:54–60

    CAS  PubMed  Google Scholar 

  • Zillikens D, Kawahara Y, Ishiko A et al (1996) A novel subepidermal blistering disease with autoantibodies against a 200-kDa antigen of the basement membrane zone. J Invest Dermatol 106:465–470

    CAS  PubMed  Google Scholar 

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Correspondence to Christian Sadik .

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Sadik, C., Zillikens, D., Hertl, M. (2020). Autoimmune Bullous Diseases. In: Plewig, G., French, L., Ruzicka, T., Kaufmann, R., Hertl, M. (eds) Braun-Falco´s Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58713-3_49-1

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  • DOI: https://doi.org/10.1007/978-3-662-58713-3_49-1

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Chapter history

  1. Latest

    Autoimmune Bullous Diseases
    Published:
    02 September 2021

    DOI: https://doi.org/10.1007/978-3-662-58713-3_49-2

  2. Original

    Autoimmune Bullous Diseases
    Published:
    29 July 2020

    DOI: https://doi.org/10.1007/978-3-662-58713-3_49-1