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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 11 | 17 |
| 2024 Octubre | 76 | 52 | 128 |
| 2024 Septiembre | 73 | 35 | 108 |
| 2024 Agosto | 122 | 56 | 178 |
| 2024 Julio | 94 | 44 | 138 |
| 2024 Junio | 98 | 46 | 144 |
| 2024 Mayo | 107 | 26 | 133 |
| 2024 Abril | 73 | 18 | 91 |
| 2024 Marzo | 78 | 37 | 115 |
| 2024 Febrero | 87 | 38 | 125 |
| 2024 Enero | 64 | 43 | 107 |
| 2023 Diciembre | 48 | 20 | 68 |
| 2023 Noviembre | 60 | 28 | 88 |
| 2023 Octubre | 66 | 23 | 89 |
| 2023 Septiembre | 81 | 36 | 117 |
| 2023 Agosto | 50 | 36 | 86 |
| 2023 Julio | 40 | 45 | 85 |
| 2023 Junio | 58 | 28 | 86 |
| 2023 Mayo | 59 | 34 | 93 |
| 2023 Abril | 43 | 41 | 84 |
| 2023 Marzo | 43 | 32 | 75 |
| 2023 Febrero | 49 | 26 | 75 |
| 2023 Enero | 36 | 43 | 79 |
| 2022 Diciembre | 65 | 40 | 105 |
| 2022 Noviembre | 24 | 40 | 64 |
| 2022 Octubre | 39 | 40 | 79 |
| 2022 Septiembre | 26 | 44 | 70 |
| 2022 Agosto | 27 | 52 | 79 |
| 2022 Julio | 30 | 52 | 82 |
| 2022 Junio | 23 | 42 | 65 |
| 2022 Mayo | 44 | 46 | 90 |
| 2022 Abril | 38 | 39 | 77 |
| 2022 Marzo | 40 | 51 | 91 |
| 2022 Febrero | 36 | 41 | 77 |
| 2022 Enero | 31 | 59 | 90 |
| 2021 Diciembre | 39 | 39 | 78 |
| 2021 Noviembre | 30 | 54 | 84 |
| 2021 Octubre | 30 | 46 | 76 |
| 2021 Septiembre | 36 | 38 | 74 |
| 2021 Agosto | 44 | 32 | 76 |
| 2021 Julio | 38 | 28 | 66 |
| 2021 Junio | 28 | 27 | 55 |
| 2021 Mayo | 40 | 28 | 68 |
| 2021 Abril | 69 | 50 | 119 |
| 2021 Marzo | 66 | 26 | 92 |
| 2021 Febrero | 57 | 32 | 89 |
| 2021 Enero | 43 | 20 | 63 |
| 2020 Diciembre | 40 | 14 | 54 |
| 2020 Noviembre | 24 | 12 | 36 |
| 2020 Octubre | 19 | 8 | 27 |
| 2020 Septiembre | 40 | 18 | 58 |
| 2020 Agosto | 29 | 9 | 38 |
| 2020 Julio | 25 | 9 | 34 |
| 2020 Junio | 40 | 31 | 71 |
| 2020 Mayo | 28 | 24 | 52 |
| 2020 Abril | 40 | 15 | 55 |
| 2020 Marzo | 32 | 18 | 50 |
| 2020 Febrero | 8 | 4 | 12 |
| 2020 Enero | 4 | 6 | 10 |
| 2019 Diciembre | 5 | 5 | 10 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 8 | 9 | 17 |
| 2019 Agosto | 4 | 6 | 10 |
| 2019 Julio | 4 | 9 | 13 |
| 2019 Junio | 4 | 7 | 11 |
| 2019 Mayo | 6 | 8 | 14 |
| 2019 Abril | 2 | 14 | 16 |
| 2019 Marzo | 2 | 10 | 12 |
| 2019 Febrero | 2 | 4 | 6 |
| 2019 Enero | 2 | 5 | 7 |
| 2018 Diciembre | 2 | 7 | 9 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 6 | 6 |
| 2018 Mayo | 0 | 13 | 13 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 1 | 3 | 4 |
| 2018 Febrero | 19 | 4 | 23 |
| 2018 Enero | 35 | 8 | 43 |
| 2017 Diciembre | 43 | 3 | 46 |
| 2017 Noviembre | 40 | 6 | 46 |
| 2017 Octubre | 30 | 4 | 34 |
| 2017 Septiembre | 37 | 14 | 51 |
| 2017 Agosto | 70 | 8 | 78 |
| 2017 Julio | 55 | 5 | 60 |
| 2017 Junio | 65 | 20 | 85 |
| 2017 Mayo | 56 | 7 | 63 |
| 2017 Abril | 49 | 11 | 60 |
| 2017 Marzo | 39 | 79 | 118 |
| 2017 Febrero | 37 | 7 | 44 |
| 2017 Enero | 26 | 7 | 33 |
| 2016 Diciembre | 42 | 9 | 51 |
| 2016 Noviembre | 47 | 10 | 57 |
| 2016 Octubre | 59 | 6 | 65 |
| 2016 Septiembre | 83 | 18 | 101 |
| 2016 Agosto | 46 | 4 | 50 |
| 2016 Julio | 28 | 6 | 34 |
| 2016 Junio | 9 | 7 | 16 |
| 2016 Mayo | 8 | 3 | 11 |
| 2016 Abril | 7 | 8 | 15 |
| 2016 Marzo | 2 | 3 | 5 |
| 2016 Febrero | 11 | 5 | 16 |
| 2016 Enero | 5 | 1 | 6 |
| 2015 Diciembre | 3 | 1 | 4 |
| 2015 Noviembre | 3 | 0 | 3 |
| 2015 Octubre | 5 | 1 | 6 |
| 2015 Septiembre | 3 | 1 | 4 |
| 2015 Agosto | 6 | 2 | 8 |
| 2015 Julio | 37 | 5 | 42 |
| 2015 Junio | 31 | 5 | 36 |
| 2015 Mayo | 40 | 9 | 49 |
| 2015 Abril | 30 | 7 | 37 |
| 2015 Marzo | 21 | 1 | 22 |
| 2015 Febrero | 20 | 3 | 23 |
| 2015 Enero | 20 | 3 | 23 |
| 2014 Diciembre | 23 | 2 | 25 |
| 2014 Noviembre | 24 | 4 | 28 |
| 2014 Octubre | 23 | 4 | 27 |
| 2014 Septiembre | 21 | 2 | 23 |
| 2014 Agosto | 18 | 2 | 20 |
| 2014 Julio | 21 | 6 | 27 |
| 2014 Junio | 31 | 6 | 37 |
| 2014 Mayo | 17 | 4 | 21 |
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