title: Childhood epidermolysis bullosa acquisita during squaric acid dibutyl ester immunotherapy for alopecia areata.
abstract: Epidermolysis bullosa acquisita (EBA) is a rare acquired subepidermal blistering disease associated with autoantibodies against type VII collagen. Although EBA manifests more frequently in adults, it can occur in childhood. We describe a 6-year-old boy who developed the inflammatory variant of EBA shortly after initiation of immunotherapy with squaric acid dibutyl ester (SADBE) for scalp alopecia areata. The disease rapidly regressed following SADBE discontinuation and starting combined steroid and dapsone therapy, and never recurred after treatment tapering and withdrawal. The association of EBA with other autoimmune diseases is common, but EBA occurring during alopecia areata has not been described previously. The development of EBA during SADBE treatment is also notable: the clinical history and therapeutic response in our patient point to a possible role of SADBE in EBA onset.
authors.affiliation: Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Guerra
authors.affiliation: 3rd Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Pacifico
authors.affiliation: Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Calabresi
authors.affiliation: Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: De Luca
authors.affiliation: Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Castiglia
authors.affiliation: 3rd Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Angelo
authors.affiliation: Genetic and Rare Diseases Research Area, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zambruno
authors.affiliation: Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, via dei Monti di Creta 104, 00167, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Zenzo
mesh_terms: D000506:Alopecia Areata / Q000188:drug therapy*; D002648:Child; D003503:Cyclobutanes / Q000009:adverse effects*; D003879:Dermatologic Agents / Q000009:adverse effects*; D016107:Epidermolysis Bullosa Acquisita / Q000139:chemically induced*; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects*; D008297:Male
chemical_list: D003503:Cyclobutanes; D003879:Dermatologic Agents; C020637:squaric acid dibutyl ester