Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

Abstract

Background and Objectives: Linear IgA disease (LAD) is a rare autoimmune blistering disease with linear IgA deposits along the basement membrane zone. Direct immunofluorescence remains the gold standard for diagnosis, but other diagnostic measures reported in recent literature have proven useful in the setting of inconclusive preliminary results. Dapsone is a commonly used treatment, but many therapeutic agents have emerged in recent years. The objective of this study is to provide a comprehensive overview of updates on the diagnosis and management of LAD. Materials and Methods: A literature search was conducted from May to June of 2021 for articles published in the last 5 years that were related to the diagnosis and management of LAD. Results: False-negative results in cases of drug-induced LAD and the presence of IgG and IgM antibodies on immunofluorescence studies were reported. Serration pattern analysis has been reported to be useful in distinguishing LAD from sublamina densa-type LAD. Rituximab, omalizumab, etanercept, IVIg, sulfonamides, topical corticosteroids, and others have been used successfully in adult and pediatric patients with varying disease severity. Topical corticosteroids were preferred for pediatric patients while rituximab and IVIg were used in adults with recalcitrant LAD. Sulfonamides were utilized in places without access to dapsone. Conclusion: In cases where preliminary biopsy results are negative and clinical suspicion is high, repeat biopsy and additional diagnostic studies should be used. Patient factors such as age, medical comorbidities, and disease severity play a role in therapeutic selection.

Autoimmune Disease Classification Based on PubMed Text Mining

“…IgG4-related sclerosing disease is a subcategory of sclerosis and is omitted from Figure 2 [ 91 ]. Likewise, linear IgA is a rare autoimmune blistering disease, with linear IgA deposits along the basement membrane zone [ 92 ]. It is associated with other bullous diseases and omitted from Figure 2 .…”

Combined dapsone and sulfapyridine for the treatment of therapy-resistant linear IgA bullous dermatosis: Two case reports

“…4 The gold-standard diagnostic method is skin biopsy including direct immunofluorescence, revealing the linear IgA deposits ( Fig 2 , E ). 2 , 10 …”

“…The evidence for the current treatment of LABD is limited and based on case reports and case series, and larger controlled trials are lacking. 4 , 10 Dapsone is generally well tolerated and is often used as a first-line therapy. 2 , 3 The dose range for the treatment of LABD in adults is 50 to 150 mg/day, while the dose range for children has been reported at 0.5 to 2 mg/kg/day.…”

Management Options for Linear Immunoglobulin A (IgA) Bullous Dermatosis: A Literature Review

“…If the patient has G6PD deficiency or sulfa allergy preventing dapsone use, oral corticosteroids alone may be utilized, even in drug-induced cases. For patients with mild LABD, topical steroids with high potency such as clobetasol propionate 0.05% may be considered as the sole treatment option as well, with the possible addition of dapsone if the disease remains uncleared [ 5 ]. Intermittent drug holidays from corticosteroids are implemented to avoid skin atrophy, striae, or telangiectasias of the skin.…”