Advertisement

Der Hautarzt

, Volume 70, Issue 4, pp 271–276 | Cite as

Anti-p200-Pemphigoid

  • M. M. HoltscheEmail author
  • S. Goletz
  • D. Zillikens
Leitthema

Zusammenfassung

Das Anti-p200-Pemphigoid ist eine seltene blasenbildende Autoimmundermatose. Es handelt sich um eine Erkrankung der Untergruppe der Pemphigoiderkrankungen und wurde erstmals 1996 beschrieben. Der Goldstandard in der Diagnostik ist die direkte Immunfluoreszenz (IF) einer periläsionalen Probebiopsie in Kombination mit dem Nachweis zirkulierender Autoantikörper mit Bindung an die dermale Seite (Blasenboden) humaner Spalthaut in der indirekten IF sowie Reaktivität mit einem 200 kDa schweren Protein (p200) im Immunoblot mit Extrakt humaner Dermis. Im Jahr 2009 wurde Laminin γ1 als zusätzliches Zielantigen in 90 % der Anti-p200-Pemphigoid-Patienten beschrieben. Da sowohl Ex-vivo- als auch In-vivo-Studien keine pathogene Relevanz von Laminin γ1 nachweisen konnten und die Präadsorption gegen Laminin γ1 die Reaktivität von Patientenseren mit p200 nicht reduzierte, bleibt die molekulare Identität des p200-Proteins weiterhin unklar. Das klinische Bild der Erkrankung ist vielseitig, in den meisten Fällen ähnelt es dem des bullösen Pemphigoids. Die Patienten sind jedoch im Durchschnitt etwas jünger und Läsionen finden sich häufiger an Palmae und Plantae als beim bullösen Pemphigoid. Therapeutisch wurden lokale und systemische Glukokortikosteroide sowie Dapson und Immunsuppressiva beschrieben.

Schlüsselwörter

Autoantikörper Blasenbildung Basalmembranzone Immunfluoreszenz Immunsuppression 

Anti-p200 pemphigoid

Abstract

Anti-p200 pemphigoid is a rare autoimmune blistering disease. It belongs to the group of pemphigoid diseases and was first described in 1996. The diagnostic gold standard is the combination of (1) linear deposits of immunoreactants at the dermal epidermal junction by direct immunofluorescence microscopy of a perilesional skin biopsy, (2) detection of circulating autoantibodies binding to the dermal side (blister floor) of human salt split skin by indirect immunofluorescence microscopy, and reactivity with a 200 kDa protein (p200) in extract of human dermis by immunoblotting. In 2009, laminin γ1 was described as an additional target antigen in 90% of anti-p200 pemphigoid patients. Since ex vivo and in vivo studies have shown no direct pathogenic relevance for laminin γ1 antibodies and the preadsorption of patient sera against laminin γ1 does not reduce their reactivity with p200, the molecular identity of p200 still remains to be elucidated. The clinical phenotype of the disease is heterogeneous; in most cases, however, it resembles bullous pemphigoid. Anti-p200 patients are younger and skin lesions more often appear on palms of the hands and soles of the feet than in bullous pemphigoid. Therapy consists of topical and systemic corticosteroids. In addition, the use of daspone and immunosuppressants has been reported.

Keywords

Autoantibodies Blister Basement membrane zone Immunofluorescence Immunosuppression 

Notes

Danksagung

Wir danken der Deutschen Forschungsgemeinschaft für die Unterstützung unserer Forschung zum Schleimhautpemphigoid im Exzellenz-Cluster 306/1 & 2 Inflammation at Interfaces und in der Klinischen Forschergruppe 306 Pemphigoid Diseases.

Einhaltung ethischer Richtlinien

Interessenkonflikt

M.M. Holtsche, S. Goletz und D. Zillikens geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

Literatur

  1. 1.
    Zillikens D, Kawahara Y, Ishiko A et al (1996) A novel subepidermal blistering disease with autoantibodies to a 200-kDa antigen of the basement membrane zone. J Invest Dermatol 106:1333–1338PubMedGoogle Scholar
  2. 2.
    Chen KR, Shimizu S, Miyakawa S et al (1996) Coexistence of psoriasis and an unusual IgG-mediated subepidermal bullous dermatosis: identification of a novel 200-kDa lower lamina lucida target antigen. Br J Dermatol 134:340–346PubMedGoogle Scholar
  3. 3.
    Dainichi T, Kurono S, Ohyama B et al (2009) Anti-laminin gamma-1 pemphigoid. Proc Natl Acad Sci U S A 106:2800–2805PubMedPubMedCentralGoogle Scholar
  4. 4.
    Salmhofer W, Kawahara Y, Soyer HP et al (1997) A subepidermal blistering disease with histopathological features of dermatitis herpetiformis and immunofluorescence characteristics of bullous pemphigoid: a novel subepidermal blistering disease or a variant of bullous pemphigoid? Br J Dermatol 137:599–604PubMedGoogle Scholar
  5. 5.
    Kawahara Y, Amagai M, Ohata Y et al (1998) A case of cicatricial pemphigoid with simultaneous IgG autoantibodies against the 180 kd bullous pemphigoid antigen and laminin 5. J Am Acad Dermatol 38:624–627PubMedGoogle Scholar
  6. 6.
    Kawahara Y, Matsuo Y, Hashimoto T et al (1998) A case of unique subepidermal blistering disease with autoantibodies against a novel dermal 200-kD antigen. Dermatology 196:213–216PubMedGoogle Scholar
  7. 7.
    Inoh Y, Nishikawa T, Hashimoto T (1998) The vesicular pemphigoid phenotype may be related to antibodies to a 200 kDa antigen in the lower lamina lucida. Br J Dermatol 139:738–739PubMedGoogle Scholar
  8. 8.
    Yasuda H, Tomita Y, Shibaki A et al (2004) Two cases of subepidermal blistering disease with anti-p200 or 180-kD bullous pemphigoid antigen associated with psoriasis. Dermatology 209:149–155PubMedGoogle Scholar
  9. 9.
    Mascaro JM Jr., Zillikens D, Giudice GJ et al (2000) A subepidermal bullous eruption associated with IgG autoantibodies to a 200 kd dermal antigen: the first case report from the United States. J Am Acad Dermatol 42:309–315PubMedGoogle Scholar
  10. 10.
    Kawahara Y, Zillikens D, Yancey KB et al (2000) Subepidermal blistering disease with autoantibodies against a novel dermal 200-kDa antigen. J Dermatol Sci 23:93–102PubMedGoogle Scholar
  11. 11.
    Zillikens D, Ishiko A, Jonkman MF et al (2000) Autoantibodies in anti-p200 pemphigoid stain skin lacking laminin 5 and type VII collagen. Br J Dermatol 143:1043–1049PubMedGoogle Scholar
  12. 12.
    Egan CA, Yee C, Zillikens D et al (2002) Anti-p200 pemphigoid: diagnosis and treatment of a case presenting as an inflammatory subepidermal blistering disease. J Am Acad Dermatol 46:786–789PubMedGoogle Scholar
  13. 13.
    Watanabe M, Tsunoda T, Tagami H (2002) A subepidermal blistering dermatosis associated with coexistent IgG and IgA anti-dermal basement membrane zone antibodies; demonstration of IgG antibodies reactive against a 200-kDa dermal antigen. Eur J Dermatol 12:603–606PubMedGoogle Scholar
  14. 14.
    Morris SD, Mallipeddi R, Oyama N et al (2002) Psoriasis bullosa acquisita. Clin Exp Dermatol 27:665–669PubMedGoogle Scholar
  15. 15.
    Umemoto N, Demitsu T, Toda S et al (2003) A case of anti-p200 pemphigoid clinically mimicking inflammatory epidermolysis bullosa acquisita. Br J Dermatol 148:1058–1060PubMedGoogle Scholar
  16. 16.
    Cho SB, Kim SC (2003) A Korean case of anti-p200 pemphigoid. Yonsei Med J 44:931–934PubMedGoogle Scholar
  17. 17.
    Furukawa H, Miura T, Takahashi M et al (2004) A case of anti-p200 pemphigoid with autoantibodies against both a novel 200-kD dermal antigen and the 290-kD epidermolysis bullosa acquisita antigen. Dermatology 209:145–148PubMedGoogle Scholar
  18. 18.
    Shimanovich I, Petersen EE, Weyers W et al (2005) Subepidermal blistering disease with autoantibodies to both the p200 autoantigen and the alpha3 chain of laminin 5. J Am Acad Dermatol 52:S90–S92PubMedGoogle Scholar
  19. 19.
    Yamada T, Suzuki M, Koike Y et al (2006) A case of epidermolysis bullosa acquisita with autoantibody to anti-p200 pemphigoid antigen and exfoliative esophagitis. Dermatology 212:381–384PubMedGoogle Scholar
  20. 20.
    Yamane N, Sawamura D, Nishie W et al (2007) Anti-p200 pemphigoid in a 17-year-old girl successfully treated with systemic corticosteroid and dapsone. Br J Dermatol 156:1075–1078PubMedGoogle Scholar
  21. 21.
    Hofmann SC, Voith U, Sasaki T et al (2008) The autoantigen in anti-p200 pemphigoid is synthesized by keratinocytes and fibroblasts and is distinct from nidogen-2. J Invest Dermatol 128:87–95PubMedGoogle Scholar
  22. 22.
    Mitsuya J, Hara H, Ito K et al (2008) Metastatic ovarian carcinoma-associated subepidermal blistering disease with autoantibodies to both the p200 dermal antigen and the gamma 2 subunit of laminin 5 showing unusual clinical features. Br J Dermatol 158:1354–1357PubMedGoogle Scholar
  23. 23.
    Goto-Ohguchi Y, Nishie W, Akiyama M et al (2009) A severe and refractory case of anti-p200 pemphigoid resulting in multiple skin ulcers and scar formation. Dermatology 218:265–271PubMedGoogle Scholar
  24. 24.
    Kasperkiewicz M, Hoppe U, Zillikens D et al (2010) Relapse-associated autoantibodies to BP180 in a patient with anti-p200 pemphigoid. Clin Exp Dermatol 35:614–617PubMedGoogle Scholar
  25. 25.
    Iwata H, Hiramitsu Y, Aoyama Y et al (2009) A case of anti-p200 pemphigoid: evidence for a different pathway in neutrophil recruitment compared with bullous pemphigoid. Br J Dermatol 160:462–464PubMedGoogle Scholar
  26. 26.
    Myers DJ, Unwala RD, Xia L et al (2011) Generalized annular bullous eruption—quiz case. Anti-laminin gamma1 pemphigoid with a linear IgA bullous dermatosis-like presentation. Arch Dermatol 147:109–114PubMedGoogle Scholar
  27. 27.
    Wozniak K, Hashimoto T, Fukuda S et al (2011) IgA anti-p200 pemphigoid. Arch Dermatol 147:1306–1310PubMedGoogle Scholar
  28. 28.
    Hayashi M, Okamura K, Ujiie H et al (2018) Case of anti-p200 pemphigoid accompanying uterine malignancy. J Dermatol.  https://doi.org/10.1111/1346-8138.14473 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Waki Y, Kamiya K, Komine M et al (2018) A case of anti-laminin gamma1 (p200) pemphigoid with psoriasis vulgaris successfully treated with apremilast. Eur J Dermatol 28:413–414PubMedGoogle Scholar
  30. 30.
    Goyal N, Rao R, Shenoi SD et al (2017) Epidermolysis bullosa acquisita and anti-p200 pemphigoid as major subepidermal autoimmune bullous diseases diagnosed by floor binding on indirect immunofluorescence microscopy using human salt-split skin. Indian J Dermatol Venereol Leprol 83:550–555PubMedGoogle Scholar
  31. 31.
    Rousseau L, Droitcourt C, Ropars N et al (2017) Successful treatment of severe anti-p200 pemphigoid in a heart transplant recipient with a single cycle of rituximab. JAAD Case Rep 3:175–177PubMedPubMedCentralGoogle Scholar
  32. 32.
    Goetze S, Dumke AK, Zillikens D et al (2017) Anti-p200/laminin gamma1 pemphigoid associated with metastatic oesophageal cancer. J Eur Acad Dermatol Venereol 31:e219–e221PubMedGoogle Scholar
  33. 33.
    Garcia-Diez I, Martinez-Escala ME, Ishii N (2017) Usefulness of a simple immunohistochemical staining technique to differentiate anti-p200 Pemphigoid from other autoimmune blistering diseases: a report of 2 cases. Actas Dermosifiliogr 108:e1–e5PubMedGoogle Scholar
  34. 34.
    Meijer JM, Diercks GF, Schmidt E et al (2016) Laboratory diagnosis and clinical profile of anti-p200 Pemphigoid. JAMA Dermatol 152:897–904PubMedGoogle Scholar
  35. 35.
    Commin MH, Schmidt E, Duvert-Lehembre S et al (2016) Clinical and immunological features and outcome of anti-p200 pemphigoid. Br J Dermatol 175:776–781PubMedGoogle Scholar
  36. 36.
    McCarty M, Zillikens D, Fivenson D (2015) Anti-p200 pemphigoid (anti-laminin-gamma1 pemphigoid) demonstrating pathergy. Int J Womens Dermatol 1:173–174PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ishida S, Takahashi K, Kanaoka M et al (2015) Case of subepidermal autoimmune bullous disease with psoriasis vulgaris reacting to both BP180 C‑terminal domain and laminin gamma-1. J Dermatol 42:391–393PubMedGoogle Scholar
  38. 38.
    Kaune KM, Kasperkiewicz M, Tams D et al (2015) Anti-p200/anti-laminin gamma1 pemphigoid and BP180 NC16A/4575-positive mucous membrane pemphigoid : late diagnosis in a patient with disease-related loss of vision and multiple previous surgical interventions. Hautarzt 66:60–64PubMedGoogle Scholar
  39. 39.
    Raffin D, Delaplace M, Roussel A et al (2013) Anti-p200 pemphigoid: Remission under mycophenolate mofetil (Cellcept(R)). Ann Dermatol Venereol 140:784–787PubMedGoogle Scholar
  40. 40.
    Shimizu A, Funakoshi T, Ishibashi M et al (2013) Immunoglobulin G deposition to nonhemidesmosomal lamina lucida and early neutrophil involvement are characteristic features in a case of anti-p200 pemphigoid. Br J Dermatol 168:647–655PubMedGoogle Scholar
  41. 41.
    Monshi B, Groth S, Richter L et al (2012) A long-term study of a patient with anti-p200 pemphigoid: correlation of autoantibody levels with disease activity and an example of epitope spreading. Br J Dermatol 167:1179–1183PubMedGoogle Scholar
  42. 42.
    Honda Y, Dainichi T, Nishie W et al (2016) Subepidermal autoimmune bullous disease affecting predominantly mucocutaneous junctions and the palms with autoantibodies to BP230 and laminin gamma1. Br J Dermatol 175:619–621PubMedGoogle Scholar
  43. 43.
    Iijima S, Okazaki Y, Watanabe S et al (2015) Case of concurrence of anti-laminin gamma-1 pemphigoid and scabies. J Dermatol 42:1024–1026PubMedGoogle Scholar
  44. 44.
    Fujimura Y, Natsuga K, Hamade Y et al (2016) Anti-laminin-gamma 1 pemphigoid with generalized pustular psoriasis and psoriasis vulgaris. Acta Derm Venereol 96:120–121PubMedGoogle Scholar
  45. 45.
    Gawaz A, Metzler G, Hertl M et al (2015) Treatment of anti-laminin gamma1 pemphigoid with mycophenolate mofetil. J Dtsch Dermatol Ges 13:696–697PubMedGoogle Scholar
  46. 46.
    Akasaka E, Nakano H, Korekawa A et al (2015) Anti-laminin gamma1 pemphigoid associated with ulcerative colitis and psoriasis vulgaris showing autoantibodies to laminin gamma1, type XVII collagen and laminin-332. Eur J Dermatol 25:198–199PubMedGoogle Scholar
  47. 47.
    Zhiliang L, Xiaodong Z, Peiying J et al (2015) A case of refractory antilaminin gamma1 pemphigoid successfully treated with dexamethasone and mycophenolate mofetil. Int J Dermatol 54:e194–6PubMedGoogle Scholar
  48. 48.
    Imanishi A, Tateishi C, Imanishi H et al (2015) Pemphigoid with antibodies to laminin gamma1, BP180 and BP230, associated with psoriasis vulgaris: successful disease control with cyclosporin. J Dermatol 42:394–397PubMedGoogle Scholar
  49. 49.
    Ansai S, Hashizume S, Kawana S et al (2014) Case of anti-laminin gamma-1 pemphigoid with antibody against C‑terminal domain of BP180 in a patient with psoriasis vulgaris. J Dermatol 41:1031–1033PubMedGoogle Scholar
  50. 50.
    Li X, Qian H, Ishii N et al (2014) A case of concurrent antilaminin gamma1 pemphigoid and antilaminin-332-type mucous membrane pemphigoid. Br J Dermatol 171:1257–1259PubMedGoogle Scholar
  51. 51.
    Igarashi M, Tsunemi Y, Koga H et al (2014) Anti-laminin gamma1 pemphigoid associated with pustular psoriasis. Eur J Dermatol 24:629–630PubMedGoogle Scholar
  52. 52.
    Ohzono A, Numata S, Hamada T et al (2015) Anti-laminin-gamma1 pemphigoid developed in a case of autosomal recessive congenital ichthyosis. Acta Derm Venereol 95:93–94PubMedGoogle Scholar
  53. 53.
    Alloo A, Strazzula L, Rothschild B et al (2014) Refractory antilaminin gamma1 pemphigoid successfully treated with intravenous immunoglobulin and mycophenolate mofetil. J Eur Acad Dermatol Venereol 28:1401–1403PubMedGoogle Scholar
  54. 54.
    Kamata M, Fujita H, Hamanaka T et al (2013) Anti-laminin gamma1 pemphigoid accompanied by autoantibodies to laminin alpha3 and gamma2 subunits of laminin-332. Jama Dermatol 149:1437–1439PubMedGoogle Scholar
  55. 55.
    Ohata C, Fukuda S, Ishii N et al (2013) Refractory anti-laminin gamma1 pemphigoid with psoriasis vulgaris successfully treated by double-filtration plasmapheresis. Eur J Dermatol 23:715–716PubMedGoogle Scholar
  56. 56.
    Kalkoff EC, Bramsiepe I, Groth S et al (2013) Anti-laminin gamma1 pemphigoid. J Dtsch Dermatol Ges 11:555–557PubMedGoogle Scholar
  57. 57.
    Majima Y, Yagi H, Tateishi C et al (2013) A successful treatment with ustekinumab in a case of antilaminin-gamma1 pemphigoid associated with psoriasis. Br J Dermatol 168:1367–1369PubMedGoogle Scholar
  58. 58.
    Munsch C, Prey S, Joly P et al (2011) Anti-p200 pemphigoid: a spectacular response to dapsone. Ann Dermatol Venereol 138:739–742PubMedGoogle Scholar
  59. 59.
    Kikuchi K, Natsuga K, Shinkuma S et al (2011) Subepidermal blistering disease with 3 distinct autoantibodies: anti-BP230, anti-laminin gamma-1, and anti-laminin-332. J Am Acad Dermatol 65:878–880PubMedGoogle Scholar
  60. 60.
    Schmidt E, Zillikens D (2013) Pemphigoid diseases. Lancet 381:320–332PubMedGoogle Scholar
  61. 61.
    Egan CA, Lazarova Z, Darling TN et al (2001) Anti-epiligrin cicatricial pemphigoid and relative risk for cancer. Lancet 357:1850–1851PubMedGoogle Scholar
  62. 62.
    Goletz S, Probst C, Komorowski L et al (2018) A sensitive and specific assay for the serological diagnosis of antilaminin 332 mucous membrane pemphigoid. Br J Dermatol.  https://doi.org/10.1111/bjd.17202 CrossRefPubMedGoogle Scholar
  63. 63.
    Schmidt E, Groves R (2016) Immunobullous diseases. In: Griffith C, Barker J, Chalmers, Bleiker T, Creamer D (Hrsg) Rook’s Textbook of Dermatology, part 3, chapter 50, 9. Aufl. Wiley-Blackwell, Chichester, S 1–56Google Scholar
  64. 64.
    Goletz S, Hashimoto T, Zillikens D et al (2014) Anti-p200 pemphigoid. J Am Acad Dermatol 71:185–191PubMedGoogle Scholar
  65. 65.
    Dilling A, Rose C, Hashimoto T et al (2007) Anti-p200 pemphigoid: a novel autoimmune subepidermal blistering disease. J Dermatol 34:1–8PubMedGoogle Scholar
  66. 66.
    Schmidt E, Zillikens D (2011) Diagnosis and treatment of patients with autoimmune bullous disorders in Germany. Dermatol Clin 29:663–671PubMedGoogle Scholar
  67. 67.
    Mitate E, Kawano S, Nakao Y et al (2013) Concurrence of autoantibodies to both laminin gamma1 and gamma2 subunits in a patient with kidney rejection response. Acta Derm Venereol 93:114–115PubMedGoogle Scholar
  68. 68.
    Groth S, Recke A, Vafia K et al (2011) Development of a simple enzyme-linked immunosorbent assay for the detection of autoantibodies in anti-p200 pemphigoid. Br J Dermatol 164:76–82PubMedGoogle Scholar
  69. 69.
    Shimanovich I, Hirako Y, Sitaru C et al (2003) The autoantigen of anti-p200 pemphigoid is an acidic noncollagenous N‑linked glycoprotein of the cutaneous basement membrane. J Invest Dermatol 121:1402–1408PubMedGoogle Scholar
  70. 70.
    Schmidt E, Reimer S, Kruse N et al (2000) Autoantibodies to BP180 associated with bullous pemphigoid release interleukin-6 and interleukin-8 from cultured human keratinocytes. J Invest Dermatol 115:842–848PubMedGoogle Scholar
  71. 71.
    Sitaru C, Kromminga A, Hashimoto T et al (2002) Autoantibodies to type VII collagen mediate Fcgamma-dependent neutrophil activation and induce dermal-epidermal separation in cryosections of human skin. Am J Pathol 161:301–311PubMedPubMedCentralGoogle Scholar
  72. 72.
    Shimanovich I, Mihai S, Oostingh GJ et al (2004) Granulocyte-derived elastase and gelatinase B are required for dermal-epidermal separation induced by autoantibodies from patients with epidermolysis bullosa acquisita and bullous pemphigoid. J Pathol 204:519–527PubMedGoogle Scholar
  73. 73.
    Gammon WR, Merritt CC, Lewis DM et al (1982) An in vitro model of immune complex-mediated basement membrane zone separation caused by pemphigoid antibodies, leukocytes, and complement. J Invest Dermatol 78:285–290PubMedGoogle Scholar
  74. 74.
    Vafia K, Groth S, Beckmann T et al (2012) Pathogenicity of autoantibodies in anti-p200 pemphigoid. PLoS ONE 7:e41769PubMedPubMedCentralGoogle Scholar
  75. 75.
    Goletz S, Zillikens D, Schmidt E (2017) Structural proteins of the dermal-epidermal junction targeted by autoantibodies in pemphigoid diseases. Exp Dermatol 26:1154–1162PubMedGoogle Scholar
  76. 76.
    Laminins DM (2010) Cell Tissue Res 339:259–268Google Scholar
  77. 77.
    Koga H, Ishii N, Dainichi T et al (2013) An attempt to develop mouse model for anti-laminin gamma1 pemphigoid. J Dermatol Sci 70:108–115PubMedGoogle Scholar
  78. 78.
    Florea F, Bernards C, Caproni M et al (2014) Ex vivo pathogenicity of anti-laminin gamma1 autoantibodies. Am J Pathol 184:494–506PubMedGoogle Scholar
  79. 79.
    Chan LS, Vanderlugt CJ, Hashimoto T et al (1998) Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol 110:103–109PubMedGoogle Scholar
  80. 80.
    Rose C, Weyers W, Denisjuk N et al (2007) Histopathology of anti-p200 pemphigoid. Am J Dermatopathol 29:119–124PubMedGoogle Scholar
  81. 81.
    Vodegel RM, Jonkman MF, Pas HH et al (2004) U‑serrated immunodeposition pattern differentiates type VII collagen targeting bullous diseases from other subepidermal bullous autoimmune diseases. Br J Dermatol 151:112–118PubMedGoogle Scholar
  82. 82.
    Dainichi T, Koga H, Tsuji T et al (2010) From anti-p200 pemphigoid to anti-laminin gamma1 pemphigoid. J Dermatol 37:231–238PubMedGoogle Scholar
  83. 83.
    Pastar Z, Rados J, Lipozencic J et al (2007) Case of concurrent epidermolysis bullosa acquisita and anti-p200 pemphigoid—how to treat it? Int J Dermatol 46:295–298PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Dermatologie, Allergologie und VenerologieUniversität zu LübeckLübeckDeutschland

Personalised recommendations