Bullous pemphigoid initially localized around the surgical wound of an arthroprothesis for coxarthrosis

Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

“…Direct immunofl uorescence microscopy of perilesional skin showing IgG and C3c deposits at the epidermal-dermal junction; (b) Direct immunofl uorescence on salt-split skin shows IgG and C3c deposits confi ned to the epidermal side of the split skin researchers propose a diff erent, more likely theory which advocates that these patients already have autoantibodies directed towards BMZ components in low titers, insuffi cient to induce immunologic response (6). Complement system activation due to antigen-antibody binding is possible only in a proinfl ammatory milieu (2). If the tissue is injured, this prerequisite is met leading to blister formation because of the following: innate immune cells (such as macrophages, neutrophils and mast cells) are activated by non-antigen-specifi c pathways and heavily infi ltrate the site; cytokines and chemokines are secreted; vasodilation increases concentration of autoantibodies (simultaneously increasing the affi nity for binding to antigens); complement system is activated and matrix metalloproteinase 9 is released by leukocytes (2,6,11).…”

“…On the other hand, some neurotransmitters and immune cell receptors can alter regional immune response, and even though the aff ected area may look clinically normal after the causing agent has disappeared, this alteration can be permanent (19). Most often implicated exogenous factors that contribute to ICD are regional chronic lymphedema, herpetic infections, vaccinations, ionizing and ultraviolet radiation, thermal burns and diff erent types of other physical injuries (2,19). In our opinion, in our patient, one ´disease´ or rather tissue injury (surgery), caused immunological alteration that led to secondary disease (LBP), which would be another good example of ICD.…”

“…Types of injury that can lead to BP vary greatly, among them, surgical procedures such as arthroplasty, are infrequently reported (2,3). Some authors attribute this rare form of disease to a novel concept in dermatology, so called "immunocompromised district" (ICD) (4).…”

Radiation port cutaneous metastases: A further example of immunocompromised district

“…In fact, as Hoyt and Cohen themselves noticed,[1] an irradiated area is prone to the development not only of tumors, but also of opportunistic infections and immune-mediated skin disorders, depicting a typical example of ‘immunocompromised cutaneous district’ (ICD). [3] Whatever the cause,[23456] the concept of ICD refers to a skin site of locoregional immune dysregulation due to an obstacle to the normal trafficking of immunocompetent cells through lymphatic channels, and/or an interference with the signals that the neuropeptides and neurotransmitters, related to peripheral nerves, send to cell membrane receptors of immunocompetent cells. Depending on which of the neurotransmitters and immune cells are involved, this destabilization could be either defective, thus predisposing to infections and tumors or excessive, thus favoring the occurrence of some immune disorders or dysimmune reactions at the sites ‘marked’ by prior clinical events or injury.…”

“…Depending on which of the neurotransmitters and immune cells are involved, this destabilization could be either defective, thus predisposing to infections and tumors or excessive, thus favoring the occurrence of some immune disorders or dysimmune reactions at the sites ‘marked’ by prior clinical events or injury. [23456]…”