Case Report: Variety of Target Antigens During 1 Year Follow-Up of a Patient Initially Diagnosed With Bullous Pemphigoid.

Autoimmune bullous diseases (AIBDs), presenting cutaneous and/or mucosal bullous lesions, are classified into pemphigus and pemphigoid diseases. A longtime observation for complicated AIBD cases is rarely reported. In this study, serum samples of one AIBD patient were collected at seven different time points during the disease course including a relapse, which were examined by our conventional and newly developed methods for the detection of autoantibodies. Interestingly, we found changes of both the presence and the titers of various autoantibodies in accordance with the changes of clinical features during the whole disease course, which indicated that the patient started as bullous pemphigoid and relapsed as concurrence of bullous pemphigoid and mucosal-dominant-type pemphigus vulgaris.

Bart's syndrome in a family affected three consecutive generations with mutation c.6007G>A in COL7A1.

Bart's syndrome (BS), characterized by aplasia cutis congenita (ACC, also called congenital localized absence of skin) and epidermolysis bullosa (EB), is diagnosed clinically based on the disorder's unique signs and symptoms. We report the case of a family, three members of which presented with ACC at birth and one had blisters on the mucous membranes. The patient was treated conservatively with topical antibacterial ointment and wet gauze dressing. Periodic follow up showed complete healing with minimal scarring. Whole-exome sequencing confirmed a heterozygous mutation (rs121912832, c.6007G>A, p.G2003R) within exon 73 of COL7A1, which was confirmed by the only two genetic studies available, is suggested to be the molecular basis for the family's disorder. As a consequence, we suggest that c.6007G>A within exon 73 of COL7A1 could be a specific mutation for BS in antenatal screening. It is of great value to extend the genetic test among affected families and uncover the mechanism behind this unique syndrome.

Lichen Sclerosus of Face: A Case Report and Review of Literature.

We present a case of lichen sclerosus (LS) involving face and review of the relevant literature since 1970. This article highlights the rarely reported manifestation of LS. Early diagnosis with dermoscopy or confocal microscopy and early treatment might help cure it, and it may have less malignant potential.

Acquired latent tuberculosis infection in psoriasis patients treated with etanercept in the People's Republic of China.

BACKGROUND: TNF-α plays a key role in host defense against mycobacterial infection, and patients receiving TNF-α blocker treatment have increased susceptibility to tuberculosis disease. In the People's Republic of China, an intermediate tuberculosis-burden country, the latent tuberculosis infection (LTBI) risk in patients with psoriasis who are treated with etanercept, the safest kind of TNF-α blocker, is unknown. OBJECTIVES: This study reports the LTBI risk in patients with psoriasis after etanercept treatment and aims to answer the question of how often rescreening for LTBI should be done in order to reduce active tuberculosis infection of patients and further reduce the incidence of active tuberculosis disease. PATIENTS AND METHODS: This retrospective review evaluated patients with moderate-to-severe chronic plaque psoriasis between 2009 and 2013. All patients were excluded tuberculosis infection and received etanercept 25 mg twice weekly, then the patients were checked for LTBI 3 months after etanercept treatment to observe the incidence of LTBI and assess the need for rescreening for LTBI every 3 months. RESULTS: We retrospectively analyzed 192 patients with psoriasis with moderate-to-severe chronic plaque whose tuberculin skin test and chest X-rays were negative and who received etanercept 25 mg twice weekly. Eighteen of them were excluded because they received less than 3 months of etanercept therapy. After treatment with etanercept, four patients were found to have LTBI. CONCLUSION: In this study, the incidence of LTBI after 3 months was four in 192 (2.1%), which is higher than the annual incidence of LTBI in the People's Republic of China (0.72%), so LTBI could be expected to occur within 3 months in psoriasis patients on etanercept. Periodic screening for LTBI in the therapy course, as well as before initiating treatment, is necessary in those patients who use a TNF-α blocker. We recommend rescreening for LTBI every 3 months.

The significance of anticardiolipin antibody and immunologic abnormality in livedoid vasculitis.

OBJECTIVE: To evaluate the significance of anticardiolipin and immunologic abnormality in the livedoid vasculitis (LV). METHODS: 30 patients with biopsy-proven LV and 30 normal controls involved in the study. Indirect immunofluorescence, immunoblot, and ELISA were used for detecting antinuclear antibody (ANA), circulating immune complex, immune globulin, anticardiophospholipin antibody (ACA), and anti-ß(2) GP1. RESULTS: ANA was positive in four patients with LV, and among them, two patients were diagnosed as Systemic Lupus Erythematosus (SLE) later. Addition to the two SLE patients, the level of ENA and immunoglobulin were normal in the rest of patients. Anticardiolipin antibodies were present in 13 (43.33%), and ß(2) GP1 was present in nine (30%) of 30 patients. There were significant differences between LV and controls. CONCLUSIONS: ACA is one of important pathogenesis of LV. Numerous heterogeneous coagulation abnormalities and thrombogenesis may involve the LV.

Study on the expression of RXRalpha in patients with psoriasis vulgaris.

Retinoic acid regulates keratinocyte proliferation and differentiation--processes that are disturbed in psoriatic skin--via binding to nuclear receptors, including retinoic acid receptor (RAR-alpha,beta,gamma) and the common heterodimer partners (RXR-alpha,beta,gamma). By RT-PCR and immunohistochemistry methods, the expression of RXRalpha was studied in psoriatic skin and controls. The expression of RXRalpha was down-regulated in patients with psoriasis; moreover, its level was related to the stage of the disease; in the progressive stage of the disease, the level of the RXRalpha was lower than in the stable stage. The results suggest that retinoid signaling is abnormal in lesional psoriatic skin, RXRalpha expression is mainly confined to differentiated keratinocytes.