isotretinoin and Pemphigus

Diagnosing IgA pemphigus and distinguishing between its 2 subtypes, intraepidermal neutrophilic IgA dermatosis type and subcorneal pustular dermatosis type, is important because treatment of IgA pemphigus has to be different from treatment of other blistering autoimmune dermatoses. We present a patient with subcorneal pustular dermatosis type of IgA pemphigus who rapidly responded to systemic treatment with isotretinoin. Specific diagnosis was established by detecting IgA serum activity to desmocollin 1 by indirect immunofluorescence microscopy on unfixed COS7 cells transfected with desmocollin 1. No IgA or IgG serum reactivity was found to recombinant forms of desmogleins 1 and 3 by an antigen-specific enzyme-linked immunosorbent assay. The disease was not effectively controlled by conventional therapeutic regimens. Systemic treatment with isotretinoin 20 mg daily led to complete clearance of skin lesions within 3 weeks. Assaying IgA serum reactivity to desmocollin 1, desmoglein 1, and desmoglein 3 as a valuable method for establishing the diagnosis and differentiating the 2 subtypes of IgA pemphigus. Isotretinoin was an effective drug in the treatment of subcorneal pustular dermatosis type of IgA pemphigus in this patient.

Topics: Aged; Cell Adhesion Molecules; Cytoskeletal Proteins; Dermatologic Agents; Desmocollins; Desmoglein 1; Desmoglein 3; Desmogleins; Desmoplakins; Diagnosis, Differential; Fluorescent Antibody Technique; Humans; Immunoglobulin A; Isotretinoin; Male; Pemphigus; Skin

Topics: Acne Vulgaris; Adolescent; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Humans; Immunoglobulin G; Isotretinoin; Keratolytic Agents; Male; Pemphigus

Topics: Adult; Female; Humans; Isomerism; Isotretinoin; Pemphigus; Tretinoin