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Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature

Pemphigoid nodularis is a rare form of pemphigoid that joins the clinical picture of prurigo nodularis and the immunological features of bullous pemphigoid, which is therapeutically challenging. Here, we analyze five female patients with a long-lasting course of nodular pemphigoid in terms of clinic...

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Autores principales: Szymanski, Konrad, Adaszewska, Alicja, Jakubowska, Beata, Kowalewski, Cezary, Pietrzyk, Ewelina, Wozniak, Katarzyna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039219/
https://www.ncbi.nlm.nih.gov/pubmed/35493472
http://dx.doi.org/10.3389/fimmu.2022.885023
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author Szymanski, Konrad
Adaszewska, Alicja
Jakubowska, Beata
Kowalewski, Cezary
Pietrzyk, Ewelina
Wozniak, Katarzyna
author_facet Szymanski, Konrad
Adaszewska, Alicja
Jakubowska, Beata
Kowalewski, Cezary
Pietrzyk, Ewelina
Wozniak, Katarzyna
author_sort Szymanski, Konrad
collection PubMed
description Pemphigoid nodularis is a rare form of pemphigoid that joins the clinical picture of prurigo nodularis and the immunological features of bullous pemphigoid, which is therapeutically challenging. Here, we analyze five female patients with a long-lasting course of nodular pemphigoid in terms of clinical and immunological characteristics and therapy. All the patients fulfilled clinical and immunological criteria of nodular pemphigoid. We applied numerous techniques allowing the proper diagnosis: direct and indirect immunofluorescence, salt split skin, ELISA, BIOCHIP, and fluorescence overlay antigen mapping using laser scanning confocal microscopy. Our study showed that 4 of 5 patients fulfilled the clinical and immunological criteria of nodular bullous pemphigoid. Two out of 4 patients presented exclusively nodular lesions; in the other two patients, blisters and erythematous lesions preceded prurigo-like lesions by a few years. The remaining patient had clinical and immunological criteria of nodular mucous membrane pemphigoid, presenting oral erosions, scarring conjunctivitis, and numerous disseminated nodules on the skin. All the patients were treated with multiple medicines; however, it was observed that the use of clobetasol propionate on the entire body plus antidepressants best controlled the disease. Pemphigoid nodularis mainly occurs in elderly women. In cases with coexisting psychological problems, antidepressants should be considered as an important complementary therapy to the basic one with clobetasol propionate.
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spelling pubmed-90392192022-04-27 Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature Szymanski, Konrad Adaszewska, Alicja Jakubowska, Beata Kowalewski, Cezary Pietrzyk, Ewelina Wozniak, Katarzyna Front Immunol Immunology Pemphigoid nodularis is a rare form of pemphigoid that joins the clinical picture of prurigo nodularis and the immunological features of bullous pemphigoid, which is therapeutically challenging. Here, we analyze five female patients with a long-lasting course of nodular pemphigoid in terms of clinical and immunological characteristics and therapy. All the patients fulfilled clinical and immunological criteria of nodular pemphigoid. We applied numerous techniques allowing the proper diagnosis: direct and indirect immunofluorescence, salt split skin, ELISA, BIOCHIP, and fluorescence overlay antigen mapping using laser scanning confocal microscopy. Our study showed that 4 of 5 patients fulfilled the clinical and immunological criteria of nodular bullous pemphigoid. Two out of 4 patients presented exclusively nodular lesions; in the other two patients, blisters and erythematous lesions preceded prurigo-like lesions by a few years. The remaining patient had clinical and immunological criteria of nodular mucous membrane pemphigoid, presenting oral erosions, scarring conjunctivitis, and numerous disseminated nodules on the skin. All the patients were treated with multiple medicines; however, it was observed that the use of clobetasol propionate on the entire body plus antidepressants best controlled the disease. Pemphigoid nodularis mainly occurs in elderly women. In cases with coexisting psychological problems, antidepressants should be considered as an important complementary therapy to the basic one with clobetasol propionate. Frontiers Media S.A. 2022-04-12 /pmc/articles/PMC9039219/ /pubmed/35493472 http://dx.doi.org/10.3389/fimmu.2022.885023 Text en Copyright © 2022 Szymanski, Adaszewska, Jakubowska, Kowalewski, Pietrzyk and Wozniak https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Szymanski, Konrad
Adaszewska, Alicja
Jakubowska, Beata
Kowalewski, Cezary
Pietrzyk, Ewelina
Wozniak, Katarzyna
Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title_full Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title_fullStr Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title_full_unstemmed Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title_short Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature
title_sort case report: pemphigoid nodularis—five patients with many years of follow-up and review of the literature
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039219/
https://www.ncbi.nlm.nih.gov/pubmed/35493472
http://dx.doi.org/10.3389/fimmu.2022.885023
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