Mixed immunobullous disease of childhood: a good response to antimicrobials.
BACKGROUND
Immunobullous diseases are uncommon in childhood. In contrast to adults, the most commonly seen is IgA-mediated chronic bullous disease of childhood (CBDC), while IgG-mediated bullous pemphigoid (BP), cicatricial pemphigoid (CP) and epidermolysis bullosa acquisita (EBA) are rare. We have demonstrated both IgG and IgA autoantibodies to basement membrane zone target antigens in eight children with 'mixed immunobullous disease of childhood'.


OBJECTIVE
To elucidate whether a dual antibody response makes these patients distinct regarding their presentation, immunopathology, course and prognosis.


METHODS
We compared the eight children showing the double antibody response with 62 children with CBDC, BP, CP and EBA in whom only one antibody isotype was demonstrated. Clinical information at presentation, clinical course and response to treatment were recorded, and immunoblotting and direct and indirect immunofluorescence (IF) were performed.


RESULTS
Six of the eight patients presented with clinical features of CBDC. In two others, it was uncertain whether they had CBDC or BP. Seven of the eight demonstrated a dual antibody response on indirect IF and three on direct IF. Immunoblotting revealed a variety of epidermal and dermal target antigens (BP230, BP180, 97-kDa protein and laminin 5). Five of the eight responded well to dapsone, two to sulphonamides, and one to systemic erythromycin alone. The clinical course was not protracted. Five are in remission 1-4 years following treatment, and three still have active disease suppressed by treatment after 6 months-2 years.


CONCLUSIONS
Although we do not know why these children have 'mixed immunobullous disease' (the dual antibody response), our results indicate that the presence of IgA is associated with a good response to treatment with antimicrobials (dapsone, sulphonamides, erythromycin), and the clinical course is no more protracted than that found in children with a single antibody response.
Powell
J
J
Department of Dermatology, The Churchill, Oxford Radcliffe Hospitals, Headington, Oxford OX3 7LJ, UK.
Kirtschig
G
G
Allen
J
J
Dean
D
D
Wojnarowska
F
F
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D001485:Basement Membrane / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D011379:Prognosis; D012867:Skin / Q000276:immunology; D012872:Skin Diseases, Vesiculobullous / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D001323:Autoantibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G