Pemphigus, IgA Treatment & Management
- Author: Lawrence S Chan, MD; Chief Editor: Dirk M Elston, MD more...
Medical Care
Medical therapy for IgA pemphigus should be directed towards reducing inflammation, because IgA pemphigus represents a group of autoimmune blistering skin diseases manifested clinically as chronic inflammation. Because IgA pemphigus is uncommon, therapy is based on the mechanism of disease and anecdotal reports.
- Generally, corticosteroids are the mainstay of treatment for IgA pemphigus.
- Dapsone also may be helpful in IgA pemphigus because of its antineutrophilic effects.
- Rapid response to treatment with adalimumab and mycophenolate mofetil was reported in 2005.[23]
The following is a selection of related clinical trials:
Activity
Usually, no restrictions are placed on patient activities; however, advise IgA pemphigus patients to avoid contact sports during the active disease state.
Amagai M, Klaus-Kovtun V, Stanley JR. Autoantibodies against a novel epithelial cadherin in pemphigus vulgaris, a disease of cell adhesion. Cell. Nov 29 1991;67(5):869-77. [Medline].
Amagai M, Koch PJ, Nishikawa T, Stanley JR. Pemphigus vulgaris antigen (desmoglein 3) is localized in the lower epidermis, the site of blister formation in patients. J Invest Dermatol. Feb 1996;106(2):351-5. [Medline].
Carayannopoulos L, Hexham JM, Capra JD. Localization of the binding site for the monocyte immunoglobulin (Ig) A-Fc receptor (CD89) to the domain boundary between Calpha2 and Calpha3 in human IgA1. J Exp Med. Apr 1 1996;183(4):1579-86. [Medline].
Gniadecki R, Bygum A, Clemmensen O, Svejgaard E, Ullman S. IgA pemphigus: the first two Scandinavian cases. Acta Derm Venereol. 2002;82(6):441-5. [Medline].
Nanda A, Dvorak R, Al-Saeed K, Al-Sabah H, Alsaleh QA. Spectrum of autoimmune bullous diseases in Kuwait. Int J Dermatol. Dec 2004;43(12):876-81. [Medline].
Suzuki M, Karube S, Kobori Y, et al. IgA pemphigus occurring in a 1-month-old infant. J Am Acad Dermatol. Feb 2003;48(2 Suppl):S22-4. [Medline].
Chorzelski TP, Beutner EH, Kowalewski C, et al. IgA pemphigus foliaceus with a clinical presentation of pemphigus herpetiformis. J Am Acad Dermatol. May 1991;24(5 Pt 2):839-44. [Medline].
Erdag G, Qureshi HS, Greer KE, Patterson JW. Immunoglobulin A pemphigus involving the perianal skin and oral mucosa: an unusual presentation. Cutis. Sep 2007;80(3):218-20. [Medline].
Ebihara T, Hashimoto T, Iwatsuki K, et al. Autoantigens for IgA anti-intercellular antibodies of intercellular IgA vesiculopustular dermatosis. J Invest Dermatol. Oct 1991;97(4):742-5. [Medline].
Hashimoto T, Ebihara T, Nishikawa T. Studies of autoantigens recognized by IgA anti-keratinocyte cell surface antibodies. J Dermatol Sci. Apr 1996;12(1):10-7. [Medline].
Hashimoto T, Inamoto N, Nakamura K, Nishikawa T. Intercellular IgA dermatosis with clinical features of subcorneal pustular dermatosis. Arch Dermatol. Aug 1987;123(8):1062-5. [Medline].
Hashimoto T, Kiyokawa C, Mori O, et al. Human desmocollin 1 (Dsc1) is an autoantigen for the subcorneal pustular dermatosis type of IgA pemphigus. J Invest Dermatol. Aug 1997;109(2):127-31. [Medline].
Ishii N, Ishida-Yamamoto A, Hashimoto T. Immunolocalization of target autoantigens in IgA pemphigus. Clin Exp Dermatol. Jan 2004;29(1):62-6. [Medline].
Karpati S, Amagai M, Liu WL, Dmochowski M, Hashimoto T, Horvath A. Identification of desmoglein 1 as autoantigen in a patient with intraepidermal neutrophilic IgA dermatosis type of IgA pemphigus. Exp Dermatol. Jun 2000;9(3):224-8. [Medline].
Wang J, Kwon J, Ding X, Fairley JA, Woodley DT, Chan LS. Nonsecretory IgA1 autoantibodies targeting desmosomal component desmoglein 3 in intraepidermal neutrophilic IgA dermatosis. Am J Pathol. Jun 1997;150(6):1901-7. [Medline].
Fujihashi K, McGhee JR, Kweon MN, et al. gamma/delta T cell-deficient mice have impaired mucosal immunoglobulin A responses. J Exp Med. Apr 1 1996;183(4):1929-35. [Medline].
Petropoulou H, Politis G, Panagakis P, Hatziolou E, Aroni K, Kontochristopoulos G. Immunoglobulin A pemphigus associated with immunoglobulin A gammopathy and lung cancer. J Dermatol. Jun 2008;35(6):341-5. [Medline].
Bruckner AL, Fitzpatrick JE, Hashimoto T, Weston WL, Morelli JG. Atypical IgA/IgG pemphigus involving the skin, oral mucosa, and colon in a child: a novel variant of IgA pemphigus?. Pediatr Dermatol. Jul-Aug 2005;22(4):321-7. [Medline].
Duker I, Schaller J, Rose C, Zillikens D, Hashimoto T, Kunze J. Subcorneal pustular dermatosis-type IgA pemphigus with autoantibodies to desmocollins 1, 2, and 3. Arch Dermatol. Oct 2009;145(10):1159-62. [Medline].
Muller R, Heber B, Hashimoto T, et al. Autoantibodies against desmocollins in European patients with pemphigus. Clin Exp Dermatol. Dec 2009;34(8):898-903. [Medline].
Chan LS, Vanderlugt CJ, Hashimoto T, et al. Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol. Feb 1998;110(2):103-9. [Medline].
Hashimoto T, Komai A, Futei Y, Nishikawa T, Amagai M. Detection of IgA autoantibodies to desmogleins by an enzyme-linked immunosorbent assay: the presence of new minor subtypes of IgA pemphigus. Arch Dermatol. Jun 2001;137(6):735-8. [Medline].
Howell SM, Bessinger GT, Altman CE, Belnap CM. Rapid response of IgA pemphigus of the subcorneal pustular dermatosis subtype to treatment with adalimumab and mycophenolate mofetil. J Am Acad Dermatol. Sep 2005;53(3):541-3. [Medline].
Gruss C, Zillikens D, Hashimoto T, et al. Rapid response of IgA pemphigus of subcorneal pustular dermatosis type to treatment with isotretinoin. J Am Acad Dermatol. Nov 2000;43(5 Pt 2):923-6. [Medline].
Ruiz-Genao DP, Hernandez-Nunez A, Hashimoto T, Amagai M, Fernandez-Herrera J, Garcia-Diez A. A case of IgA pemphigus successfully treated with acitretin. Br J Dermatol. Nov 2002;147(5):1040-2. [Medline].
Amagai M, Tsunoda K, Suzuki H, Nishifuji K, Koyasu S, Nishikawa T. Use of autoantigen-knockout mice in developing an active autoimmune disease model for pemphigus. J Clin Invest. Mar 2000;105(5):625-31. [Medline].
Beutner EH, Chorzelski TP, Wilson RM, et al. IgA pemphigus foliaceus. Report of two cases and a review of the literature. J Am Acad Dermatol. Jan 1989;20(1):89-97. [Medline].
Coffman RL, Shrader B, Carty J, Mosmann TR, Bond MW. A mouse T cell product that preferentially enhances IgA production. I. Biologic characterization. J Immunol. Dec 1 1987;139(11):3685-90. [Medline].
de Oliveira JP, Gabbi TV, Hashimoto T, et al. Two Brazilian cases of IgA pemphigus. J Dermatol. Dec 2003;30(12):886-91. [Medline].
Hall RP, Lawley TJ. Characterization of circulating and cutaneous IgA immune complexes in patients with dermatitis herpetiformis. J Immunol. Sep 1985;135(3):1760-5. [Medline].
Hodak E, David M, Ingber A, et al. The clinical and histopathological spectrum of IgA-pemphigus--report of two cases. Clin Exp Dermatol. Nov 1990;15(6):433-7. [Medline].
Huff JC, Golitz LE, Kunke KS. Intraepidermal neutrophilic IgA dermatosis. N Engl J Med. Dec 26 1985;313(26):1643-5. [Medline].
Robinson ND, Hashimoto T, Amagai M, Chan LS. The new pemphigus variants. J Am Acad Dermatol. May 1999;40(5 Pt 1):649-71; quiz 672-3. [Medline].
Tagami H, Iwatsuki K, Iwase Y, Yamada M. Subcorneal pustular dermatosis with vesiculo-bullous eruption. Demonstration of subcorneal IgA deposits and a leukocyte chemotactic factor. Br J Dermatol. Nov 1983;109(5):581-7. [Medline].
Wallach D, Janssen F, Vignon-Pennamen MD, Lemarchand-Venencie F, Cottenot F. Atypical neutrophilic dermatosis with subcorneal IgA deposits. Arch Dermatol. Jun 1987;123(6):790-5. [Medline].
Weisbart RH, Kacena A, Schuh A, Golde DW. GM-CSF induces human neutrophil IgA-mediated phagocytosis by an IgA Fc receptor activation mechanism. Nature. Apr 14 1988;332(6165):647-8. [Medline].
Zillikens D, Miller K, Hartmann AA, Burg G. IgA pemphigus foliaceus: a case report. Dermatologica. 1990;181(4):304-7. [Medline].

