Case and research letter
Dyshidrosiform Linear Immunoglobulin A Dermatosis
Dermatosis Inmunoglobulina A lineal dishidrosiforme
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Borja-Consigliere, N. Ormaechea-Pérez, C. Lobo-Morán, A. Tuneu-Valls" "autores" => array:4 [ 0 => array:4 [ "nombre" => "H.A." "apellidos" => "Borja-Consigliere" "email" => array:2 [ 0 => "hborja@uc.cl" 1 => "hernanborja@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "N." "apellidos" => "Ormaechea-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Lobo-Morán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Tuneu-Valls" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Dermatología, Hospital Universitario Donostia, San Sebastián, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Donostia, San Sebastián, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatosis Inmunoglobulina A lineal dishidrosiforme" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 712 "Ancho" => 951 "Tamanyo" => 172257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Direct immunofluorescence showing linear and homogeneous immunoglobulin A deposition.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dyshidrosiform eruptions have a broad differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Linear immunoglobulin (Ig) A dermatosis is a rare, autoimmune blistering disease that can be idiopathic or drug-induced,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and is characterized by a linear deposit of IgA in the epidermal basement membrane.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> We describe a case of linear IgA dermatosis that began as a dyshidrosiform eruption.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 56-year-old woman presented at the emergency room with palmoplantar blisters and vesicles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) that were very painful and itchy and had appeared 24<span class="elsevierStyleHsp" style=""></span>hours previously. She was diagnosed with dyshidrosis. Several days later she developed blisters on the trunk and extremities, without mucosal involvement. A biopsy of one of the lesions was performed. Three weeks previously the patient had been treated for a urinary tract infection with oral fosfomycin, and had experienced diarrhea secondary to the antibiotic treatment. Laboratory tests, including indirect immunofluorescence analysis of antinuclear, antitransglutaminase, anti-intercellular adhesion, and anti-basement membrane antibodies, were normal. Histopathology revealed subepidermal blisters that contained a papillary dermal infiltrate consisting of abundant neutrophils and formed noneosinophilic microabscesses at the tips of the papillary ridges. Direct immunofluorescence (DIF) revealed linear IgA deposition in the epidermal basement membrane, but no deposits of IgG or C3 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Based on these findings the patient was diagnosed with linear IgA dermatosis. She responded well to treatment with oral prednisone with no recurrence within 6 months of stopping treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">While the initial appearance of palmoplantar vesicles and blisters suggested a diagnosis of dyshidrotic eczema, the subsequent appearance of lesions on the trunk and extremities was indicative of a blistering disease. Histopathology and the results of the DIF led to a diagnosis of linear IgA dermatosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Linear IgA dermatosis can be clinically and histologically similar to bullous pemphigoid and dermatitis herpetiformis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These 3 entities are characterized by subepidermal blister formation, an inflammatory infiltrate, and immunoglobulin deposition in the epidermal basement membrane. They can be distinguished by histological analysis and DIF. In dyshidrosiform pemphigoid the inflammatory infiltrate is composed mainly of eosinophils, and DIF shows a linear deposition of IgG and C3.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Cases of IgA pemphigoid involving linear deposition of IgA and C3<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> have also been reported. In dermatitis herpetiformis abundant neutrophils are observed at the tips of the dermal papillae and DIF shows granular deposition of IgA.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In linear IgA dermatosis the inflammatory infiltrate is composed mainly of neutrophils, and DIF reveals linear IgA deposition in the epidermal basement membrane.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It should be noted that although dyshidrosiform linear IgA dermatosis is rare, several cases have been reported.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> This clinical form was first described in 1988 by Barth and coworkers,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> who reported 3 cases. Another case was later described by Duhra and colleagues.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> All 4 cases featured palmar involvement. Dyshidrosiform linear IgA dermatosis can be induced by drugs, most commonly vancomycin.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,9,10</span></a> While no association between fosfomycin and linear IgA dermatosis has been described, we cannot rule out the possibility that fosfomycin acted as a trigger in the present case. Treatment involves the administration of dapsone, together with corticosteroids in refractory cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We have presented this case so that linear IgA dermatosis can be included within the broad differential diagnosis of dyshidrosiform eruptions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Borja-Consigliere H, Ormaechea-Pérez N, Lobo-Morán C, Tuneu-Valls A. Dermatosis Inmunoglobulina A lineal dishidrosiforme. 2014;105:429–430.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 507 "Ancho" => 950 "Tamanyo" => 73500 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Palmoplantar vesicles of 24<span class="elsevierStyleHsp" style=""></span>hours duration.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 712 "Ancho" => 951 "Tamanyo" => 172257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Direct immunofluorescence showing linear and homogeneous immunoglobulin A deposition.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adapted from Wollina,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> 2010.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Infantile acropustulosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Fixed drug eruption \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adult T-cell lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Friction blisters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bullous impetigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pemphigus vulgaris \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyshidrosiform pemphigoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polymorphic eruption of pregnancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear immunoglobulin A dermatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pustular psoriasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidermolysis bullosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema multiforme \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scabies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand-foot-mouth syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcorneal pustular dermatosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Herpes infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small vessel vasculitis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab493183.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 11 | 18 |
| 2024 October | 76 | 52 | 128 |
| 2024 September | 73 | 35 | 108 |
| 2024 August | 122 | 56 | 178 |
| 2024 July | 94 | 44 | 138 |
| 2024 June | 98 | 46 | 144 |
| 2024 May | 107 | 26 | 133 |
| 2024 April | 73 | 18 | 91 |
| 2024 March | 78 | 37 | 115 |
| 2024 February | 87 | 38 | 125 |
| 2024 January | 64 | 43 | 107 |
| 2023 December | 48 | 20 | 68 |
| 2023 November | 60 | 28 | 88 |
| 2023 October | 66 | 23 | 89 |
| 2023 September | 81 | 36 | 117 |
| 2023 August | 50 | 36 | 86 |
| 2023 July | 40 | 45 | 85 |
| 2023 June | 58 | 28 | 86 |
| 2023 May | 59 | 34 | 93 |
| 2023 April | 43 | 41 | 84 |
| 2023 March | 43 | 32 | 75 |
| 2023 February | 49 | 26 | 75 |
| 2023 January | 36 | 43 | 79 |
| 2022 December | 65 | 40 | 105 |
| 2022 November | 24 | 40 | 64 |
| 2022 October | 39 | 40 | 79 |
| 2022 September | 26 | 44 | 70 |
| 2022 August | 27 | 52 | 79 |
| 2022 July | 30 | 52 | 82 |
| 2022 June | 23 | 42 | 65 |
| 2022 May | 44 | 46 | 90 |
| 2022 April | 38 | 39 | 77 |
| 2022 March | 40 | 51 | 91 |
| 2022 February | 36 | 41 | 77 |
| 2022 January | 31 | 59 | 90 |
| 2021 December | 39 | 39 | 78 |
| 2021 November | 30 | 54 | 84 |
| 2021 October | 30 | 46 | 76 |
| 2021 September | 36 | 38 | 74 |
| 2021 August | 44 | 32 | 76 |
| 2021 July | 38 | 28 | 66 |
| 2021 June | 28 | 27 | 55 |
| 2021 May | 40 | 28 | 68 |
| 2021 April | 69 | 50 | 119 |
| 2021 March | 66 | 26 | 92 |
| 2021 February | 57 | 32 | 89 |
| 2021 January | 43 | 20 | 63 |
| 2020 December | 40 | 14 | 54 |
| 2020 November | 24 | 12 | 36 |
| 2020 October | 19 | 8 | 27 |
| 2020 September | 40 | 18 | 58 |
| 2020 August | 29 | 9 | 38 |
| 2020 July | 25 | 9 | 34 |
| 2020 June | 40 | 31 | 71 |
| 2020 May | 28 | 24 | 52 |
| 2020 April | 40 | 15 | 55 |
| 2020 March | 32 | 18 | 50 |
| 2020 February | 8 | 4 | 12 |
| 2020 January | 4 | 6 | 10 |
| 2019 December | 5 | 5 | 10 |
| 2019 November | 4 | 6 | 10 |
| 2019 October | 0 | 6 | 6 |
| 2019 September | 8 | 9 | 17 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 9 | 13 |
| 2019 June | 4 | 7 | 11 |
| 2019 May | 6 | 8 | 14 |
| 2019 April | 2 | 14 | 16 |
| 2019 March | 2 | 10 | 12 |
| 2019 February | 2 | 4 | 6 |
| 2019 January | 2 | 5 | 7 |
| 2018 December | 2 | 7 | 9 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 0 | 4 |
| 2018 June | 0 | 6 | 6 |
| 2018 May | 0 | 13 | 13 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 1 | 3 | 4 |
| 2018 February | 19 | 4 | 23 |
| 2018 January | 35 | 8 | 43 |
| 2017 December | 43 | 3 | 46 |
| 2017 November | 40 | 6 | 46 |
| 2017 October | 30 | 4 | 34 |
| 2017 September | 37 | 14 | 51 |
| 2017 August | 70 | 8 | 78 |
| 2017 July | 55 | 5 | 60 |
| 2017 June | 65 | 20 | 85 |
| 2017 May | 56 | 7 | 63 |
| 2017 April | 49 | 11 | 60 |
| 2017 March | 39 | 79 | 118 |
| 2017 February | 37 | 7 | 44 |
| 2017 January | 26 | 7 | 33 |
| 2016 December | 42 | 9 | 51 |
| 2016 November | 47 | 10 | 57 |
| 2016 October | 59 | 6 | 65 |
| 2016 September | 83 | 18 | 101 |
| 2016 August | 46 | 4 | 50 |
| 2016 July | 28 | 6 | 34 |
| 2016 June | 9 | 7 | 16 |
| 2016 May | 8 | 3 | 11 |
| 2016 April | 7 | 8 | 15 |
| 2016 March | 2 | 3 | 5 |
| 2016 February | 11 | 5 | 16 |
| 2016 January | 5 | 1 | 6 |
| 2015 December | 3 | 1 | 4 |
| 2015 November | 3 | 0 | 3 |
| 2015 October | 5 | 1 | 6 |
| 2015 September | 3 | 1 | 4 |
| 2015 August | 6 | 2 | 8 |
| 2015 July | 37 | 5 | 42 |
| 2015 June | 31 | 5 | 36 |
| 2015 May | 40 | 9 | 49 |
| 2015 April | 30 | 7 | 37 |
| 2015 March | 21 | 1 | 22 |
| 2015 February | 20 | 3 | 23 |
| 2015 January | 20 | 3 | 23 |
| 2014 December | 23 | 2 | 25 |
| 2014 November | 24 | 4 | 28 |
| 2014 October | 23 | 4 | 27 |
| 2014 September | 21 | 2 | 23 |
| 2014 August | 18 | 2 | 20 |
| 2014 July | 21 | 6 | 27 |
| 2014 June | 31 | 6 | 37 |
| 2014 May | 17 | 4 | 21 |
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