A Retrospective Analysis of Patients With Bullous Pemphigoid Treated With Methotrexate

Kjellman, Petra; Eriksson, Hanna; Berg, Peter

doi:10.1001/archderm.144.5.612

Cited by 73 publications

(82 citation statements)

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“…22 Finally, several dermatologic conditions, most notably bullous pemphigoid and dermatitis herpetiformis, can be associated with blood eosinophilia. In 2 separate series, 26,27 the incidence of peripheral blood eosinophilia in bullous pemphigoid was 50% and 50.9%, respectively. In most cases, the elevation is mild to moderate, with a median AEC of 1300/lL in patients with eosinophilia.…”

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confidence: 93%

“…In most cases, the elevation is mild to moderate, with a median AEC of 1300/lL in patients with eosinophilia. 27 Both diseases have characteristic patterns of immunoglobulin deposition. Hemidesmosome-specific IgG is present in a linear pattern on epithelial basement membranes in bullous pemphigoid, and granular IgA deposition is observed in the papillary dermis of patients with dermatitis herpetiformis.…”

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confidence: 99%

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Diagnostic Complexities of Eosinophilia

Montgomery

Dunphy

Mooberry

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The advent of molecular tools capable of subclassifying eosinophilia has changed the diagnostic and clinical approach to what was classically called hypereosinophilic syndrome. Objectives.— To review the etiologies of eosinophilia and to describe the current diagnostic approach to this abnormality. Data Sources.— Literature review. Conclusions.— Eosinophilia is a common, hematologic abnormality with diverse etiologies. The underlying causes can be broadly divided into reactive, clonal, and idiopathic. Classically, many cases of eosinophilia were grouped together into the umbrella category of hypereosinophilic syndrome, a clinical diagnosis of exclusion. In recent years, an improved mechanistic understanding of many eosinophilias has revolutionized the way these disorders are understood, diagnosed, and treated. As a result, specific diagnoses can now be assigned in many cases that were previously defined as hypereosinophilic syndrome. Most notably, chromosomal rearrangements, such as FIP1L1-PDGFRA fusions caused by internal deletions in chromosome 4, are now known to be associated with many chronic eosinophilic leukemias. When present, these specific molecular abnormalities predict response to directed therapies. Although an improved molecular understanding is revolutionizing the treatment of patients with rare causes of eosinophilia, it has also complicated the approach to evaluating and treating eosinophilia. Here, we review causes of eosinophilia and present a framework by which the practicing pathologist may approach this diagnostic dilemma. Finally, we consider recent cases as clinical examples of eosinophilia from a single institution, demonstrating the diversity of etiologies that must be considered.

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confidence: 93%

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confidence: 99%

Diagnostic Complexities of Eosinophilia

Montgomery

Dunphy

Mooberry

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Methotrexate was found to be effective as first-line treatment with short-term TCS in a retrospective study [5], and a prospective trial is being conducted in France. Methotrexate is also effective as a steroid-sparing agent in BP and is now recommended in France as second-line therapy after excluding contraindications, in contrast with other countries, where azathioprine is the drug of choice [4,5,21,22,23,24]. …”

Section: Discussionmentioning

confidence: 99%

Positive Direct Immunofluorescence Is of Better Value than ELISA-BP180 and ELISA-BP230 Values for the Prediction of Relapse after Treatment Cessation in Bullous Pemphigoid: A Retrospective Study of 97 Patients

Ingen‐Housz‐Oro

Plée

Belmondo³

et al. 2015

Dermatology

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Background: ELISA-BP180 values and direct immunofluorescence (DIF) are prognostic factors for relapse after treatment cessation in bullous pemphigoid (BP). Objective: To determine the relevance of ELISA-BP230 antibodies for predicting relapse 6 months after treatment cessation. Methods: We retrospectively selected patients with BP and available data from ELISA-BP180 and -BP230 and DIF performed at treatment cessation. The rate of relapse was calculated at 6 months. We compared ELISA-BP180 and -BP230 values and DIF in patients with relapse and remission. Results: We included 97 patients. At 6 months, 25.6% of patients showed relapse. The proportion of patients with an ELISA-BP230 value ≥27 UA/ml was higher, but not significantly, for those with relapse than for those with remission (p = 0.11). The frequency of positive DIF findings was significantly higher for patients with relapse (p = 0.005). Conclusion: DIF is of better value than ELISA-BP180 and -230 tests to predict relapse after treatment cessation in BP.

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“…Auch weitere immunsuppressive Medikamente werden in Kombination mit systemischen Steroiden benutz. Dabei sollten vor allem Aza thioprin [11,12], Mycophenolat-Mofetil [12], Methotrexat [13,14], Dapson [15,16] und Doxycyclin [17] genannt werden. Vereinzelte erfolgreiche Behandlungsversuche mit Ciclosporin A [18], Ciclophosphamid [19] und Rituximab [20][21][22] wurden auch berichtet, wobei diese Substanzen nicht im Regelfall zur Behandlung des bullösen Pemphigoids empfohlen werden [9].…”

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Bullöses Pemphigoid

Megahed

2014

Hautarzt

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A Retrospective Analysis of Patients With Bullous Pemphigoid Treated With Methotrexate

Cited by 73 publications

References 23 publications

Diagnostic Complexities of Eosinophilia

Diagnostic Complexities of Eosinophilia

Positive Direct Immunofluorescence Is of Better Value than ELISA-BP180 and ELISA-BP230 Values for the Prediction of Relapse after Treatment Cessation in Bullous Pemphigoid: A Retrospective Study of 97 Patients

Bullöses Pemphigoid

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