Ionizing Radiation-Induced Pemphigus

Abstract

Reports of pemphigus following ionizing radiation exposure are rare. We report two cases and review the literature regarding this association. Characteristics common to these cases include a prodromal persistent nonspecific dermatitic eruption that is often interpreted as radiation dermatitis, and latency of variable duration before the onset of a vesiculobullous eruption that begins at the portal of irradiation. Direct immunofluorescence is positive for intercellular IgG, while indirect immunofluorescence is commonly positive only at low titers; HLA correlations have not been studied. Documentation of clinical course and laboratory confirmation of the diagnosis, including hematoxylin-eosin, direct and indirect immunofluorescence, and HLA determinations (if available), should be recorded to enable further clarification of this entity.

Trauma‐induced pemphigus: a case series of 36 patients

“…The small number of reports of trauma‐induced pemphigus may be due to the overall rarity of immunobullous diseases. There have been few case reports of new pemphigus lesions developing at the sites of ionizing radiation , surgical procedures , burns and chemical peels .…”

“…Pemphigus is a group of autoimmune blistering diseases of the mucous membrane and/or skin characterized by intraepidermal acantholytic blisters. Several factors such as drugs , stressful events , previous dermatosis , radiation , burns , electrical injury , and surgery have been suggested to trigger pemphigus.…”

Pemphigus vulgaris presenting in a radiation portal

“…Previous reports have implicated ionizing radiation therapy as an inducing factor in cases of PV. [10][11][12][13] Similarly, pemphigus foliaceus, bullous pemphigoid, and paraneoplastic pemphigus have been induced by ionizing radiation. [14][15][16][17] Prior theories for the appearance of pemphigus in irradiated fields include release of previously sequestered antigens, modification of antigenic targets, or decreased immunosurveillance.…”

Trauma‐induzierter Pemphigus: eine Fallserie von 36 Patienten

“…Unter dem Begriff Pemphigus wird eine Gruppe von blasenbildenden Autoimmunkrankheiten der Schleimhäute und/oder der Haut zusammengefasst, die durch intraepidermale akantholytische Blasen gekennzeichnet sind. Verschiedene Faktoren wie Arzneimittel , stressreiche Ereignisse , frühere Dermatosen , Bestrahlung , Verbrennungen , elektrizitätsbedingte Verletzungen und chirurgische Eingriffe wurden als Auslöser für Pemphigus vorgeschlagen.…”

“…Die geringe Zahl an Berichten über traumainduzierten Pemphigus ist vermutlich auf die generelle Seltenheit von blasenbildenden Autoimmunerkrankungen zurückzuführen. Es liegen einige Fallberichte über neu aufgetretene Pemphigus‐Läsionen am Ort von Bestrahlungen , Operationen , Verbrennungen und chemischen Peelings vor.…”