The Frequency of Serum IgA autoantibody in Patients with Pemphigus / 대한피부과학회지

BACKGROUND: Pemphigus is an autoimmune bullous disease with circulating desmosomal autoantibodies of IgG. In direct IF studies with perilesional tissue, IgA or IgM antibodies can be seen in addition to IgG. OBJECTIVE: We examined sera of patients with pemphigus for the presence/frequency of IgA autoantibodies as well as IgG by indirect IF and immunoblot assay. Patients: Twenty patients of pemphigus (PV 10, PF 10) who showed positive findings in indirect IF examinations. METHODS: Indirect IF study with normal human skin substrates and immunoblot analysis using A431 cell extracts (with multi-step immunostaining) were performed with patients sera. RESULTS: In indirect IF, IgA autoantibodies that bind to the epidermal keratinocyte antigens were detected in 4 cases among the 20 patients (PV 2 and PF 2). In immunoblot analysis IgA bands reacting to PV/PF antigens were observed in 7 cases from the 20 patients with pemphigus (PV 3, PF 4). The serum titers of IgA autoantibodies were lower than those of IgG in every single case. CONCLUSION: In patients with pemphigus (PV/PF), 35% of cases have serum IgA autoantibodies as well as IgG autoantibodies specific to the pemphigus antigens (Dsg 1/Dsg 3). However, pathogenic roles of the associated IgA autoantibody are not clear.

Clinical Features of Morbilliform Erythema in Patients with Systemic Lupus Erythematosus / 대한피부과학회지

BACKGROUND: In patients with systemic lupus erythematosus(SLE), LE-specific cutaneous lesions include malar rashes, widespread/morbilliform erythema, oral ulcer and bullous lesions. OBJECTIVE: Clinical observations were carried out to define cutaneous features of morbilliform erythema and to see possible relevancy of this erythema to disease activity of SLE. METHODS: Examinations were performed on 7 SLE patients with morbilliform erythema regarding the distribution and course of the cutaneous lesions; some SLE-activity related hematologic/immunologic data taken during/around the time of this skin disease were also assessed in each patient. RESULTS: In most of those patients with morbilliform erythema, which covered the trunk and extremities, the skin lesions lasted for about 2 weeks until their disappearance. At or around the time of suffering from this skin disease of acute eutaneous LE, activities of systemic disease were recognized as "in a state of flare-up or aggravation" with hypocomplementemia and high titers of anti-nDNA autoantibodies. CONCLUSION: As with malar rashes, morbilliform erythema of acute cutaneous LE seems to develop more frequently at the time of severe systemic involvement of immunopathological processes of SLE.

The Effects of Continuous Epidural Blockade in the Treatment of Postherpetic Neuralgia / 대한피부과학회지

BACKGROUND: Postherpetic neuralgia is usually defined as pain persisting for more than one month after the onset of the eruption of herpes zoster, although there is a overlap between this and the pain of the acute zoster. Many approaches have been proposed to treat postherpetic neuralgia, however, it remains a source of frustration for both patients and physicians. OBJECTIVE: The purpose of this study was to determine more precisely the relationship between the effects of continuous epidural blockade and the time of treatment on postherpetic neuralgia. METHODS: We analyzed the results of 5 patients with postherpetic neuralgia for whom continuous epidural blockade was performed within 1 month after the onset of postherpetic neuralgia, and compared them with the results of 5 patients for whom continuous epidural blockade was performed after 1 month after the onset of postherpetic neuralgia. RESULTS: Continuous epidural blockade performed within 1 month after the onset of postherpetic neuralgia reduced pain significantly, compared to the results of continuous epidural blockade performed after 1 month after the onset of postherpetic neuralgia. CONCLUSION: Continuous epidural blockade performed within 1 month after the onset of postherpetic neuralgia may be the treatment of choice for the pain.

Three Cases of Trauma-induced Development of Isomorphic Lesions in Morphea / 대한피부과학회지

We describe three cases of morphea which present lesions of the disease at the site of mechanical traumas. In these patients, local traumatization of cutaneous tissue appear to be the initiating event for the developrnent of new lesions (isomorphic phenomenon) associated with their possible morphea prone constitutions. The mechanism involving these local stimuli responsible for the excessive collagen production is lifficult to explain. Upon biologic stress or trauma, normal cutaneous physiology may cause loca production and release of inflammatory mediators/cytokines, such as transforrning growth factor-beta(the major connective tissue growth factor-inducer). Perhaps, possible dysregulation of collagen-growth or fibrosis- promoting cytokines causing some clonal overactivity of the fibroblast, or with other undefined mechanisms may cause excessive synthesis of collagen to the local effects of such triggering factors in susceptible/subclinical individuals. Although no definite environrriental/physical influences on the developrnent of morphea have been described, rnechanical trauma niay occasionally be regarded as a contributing factor as seen in these patients.

The Pattern of Epidermal Immune Deposits in Patients with High - Titer Anti - Ro Positive Lupus Erythematosus / 대한피부과학회지

BACKGROUND: Antibodies to Bo antigen are present in most patients with subacute cutaneous lupus erythematosus and in about 50% of Korean patients with systemic lupus erythematosus (LE). However, the pattern of in vivo epidermal deposits of anti Ro antibodies has not been widely recognized. OBJECTIVE: The purpose of thjs study was to define characteristic findings of direct and indirect immunofluorescence(IF) in patients with high-titer anti-Ro or anti-Ro/La positive LE. METHODS: Lupus band test (riirect IF with normal appearing forearm skin specimens) and indi- rect IF with normal skin substr ates were performed with 3 patients of systemic LE who have high titers( >1: 640) of anti-Ro or anti-Ro/La antibodies but have no antibodies against other nuclear antigens such as nDNA/Sm/nRNP/Scl-70. RESULTS: An identical pattern of immune deposits was observed in the epidermis in all 3 pa- tients through direct and indirect, IF examinations. The characteristic pattern recognized was "fine speckling" of IgG (or IgG/IgM) mainly at the nuclei on the basal keratinocytes or keratinocytes throught the epidermis. In the immunoblot assay performed with one patient, IgG anti-Ro/La anti- bodies were identified to recognize the 52/42kD antigens (probably, the Ro/La antigens) in the cultured keratinocyte extracts. CONCLUSION: Most direct IF studies in patients with systemic LE(lupus band test) have shown granular depositions of immunoglabulins and complement components along the dermoepidermal junction, however, the staining patterns as observed in this study may have been overlooked. The recognizable fine speckled patteen of immune deposits at the epidermal keratinocytes could he taken into account as a positivi. finding in the broad category of "lupus band", seen with the normal appearing skin in patient s with systemic LE, especially, who have high titers of anti-Ro/ La antibodies.