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Published: July 2015

Open Access Gateway

Diaminodiphenyl Sulfone-Induced Hemolytic Anemia and Alopecia in a Case of Linear IgA Bullous Dermatosis

Akasaka E.a · Kayo S.-J.a · Nakano H.a · Ishii N.b · Hashimoto T.c · Sawamura D.a

Author affiliations

aDepartment of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, and bDepartment of Dermatology, Kurume University School of Medicine, and cKurume University Institute of Cutaneous Cell Biology, Kurume, Japan

Corresponding Author

Eijiro Akasaka, MD, PhD

Department of Dermatology, Hirosaki University Graduate School of Medicine

5 Zaifu-cho

Hirosaki 036-8562 (Japan)

E-Mail eijiro_akasaka@yahoo.co.jp

Related Articles for ""

Case Rep Dermatol 2015;7:183-186

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Abstract

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is an autoimmune mucocutaneous disease characterized by subepidermal blistering induced by IgA autoantibodies against several autoantigens in the basal membranous zone of the skin and mucosal tissue. Although diaminodiphenyl sulfone (DDS), also known as dapsone, is generally recognized as the first-line therapy for LABD, DDS can induce several severe side effects. We present a Japanese case of LABD with DDS-induced hemolytic anemia and alopecia. In the present case, the DDS-induced hemolytic anemia and hair loss made the DDS monotherapy difficult. When DDS is used in LABD patients with iron deficiency anemia (IDA), hemolytic anemia is concealed by IDA. It is thus necessary to carefully and frequently examine the laboratory data to find the signs of DDS-induced hemolytic anemia. Even though there is no literature on DDS-induced alopecia, alopecia was reported as one of the side effects of DDS in an FDA report, and, in our case, hair loss was improved after reducing its dosage. We have to recognize that alopecia is one of the side effects of DDS and that careful management is needed in order not to overlook the adverse side effects of DDS when treating LABD patients.

© 2015 S. Karger AG, Basel


References

  1. Sugi T, Hashimoto T, Hibi T, Nishikawa T: Production of human monoclonal anti-basement membrane zone (BMZ) antibodies from a patient with bullous pemphigoid (BP) by Epstein-Barr virus transformation. Analyses of the heterogeneity of anti-BMZ antibodies in BP sera using them. J Clin Invest 1989;84:1050-1055.
  2. Ishii N, Yoshida M, Hisamatsu Y, Ishida-Yamamoto A, Nakane H, Iizuka H, Tanaka T, Hashimoto T: Epidermolysis bullosa acquisita sera react with distinct epitopes on the NC1 and NC2 domains of type VII collagen: study using immunoblotting of domain-specific recombinant proteins and postembedding immunoelectron microscopy. Br J Dermatol 2004;150:843-851.
  3. Matsumura K, Amagai M, Nishikawa T, Hashimoto T: The majority of bullous pemphigoid and herpes gestationis serum samples react with NC16a domain of the 180-kDa bullous pemphigoid antigen. Arch Dermatol Res 1996;288:507-509.
  4. Nie Z, Hashimoto T: IgA antibodies of cicatricial pemphigoid sera specifically react with C-terminus of BP180. J Invest Dermatol 1999;112:254-255.
  5. Hisamatsu Y, Nishiyama T, Amano S, Matsui C, Ghohestani R, Hashimoto T: Usefulness of immunoblotting using purified laminin 5 in the diagnosis of anti-laminin 5 cicatricial pemphigoid. J Dermatol Sci 2003;33:113-119.
  6. Ishii N, Ohyama B, Yamaguchi Z, Hashimoto T: IgA autoantibodies against the NC16a domain of BP180 but not 120-kDa LAD-1 detected in a patient with linear IgA disease. Br J Dermatol 2008;158:1151-1153.
  7. Jabłońska S: The therapies for linear IgA bullous dermatosis of childhood. Pediatr Dermatol 1999;16:415.
    External Resources
  8. Wojnarowska F: Linear IgA dapsone responsive bullous dermatosis. J R Soc Med 1980;73:371-373.
    External Resources
  9. Jabłońska S, Chorzelski TP, Rosinska D, Maciejowska E: Linear IgA bullous dermatosis of childhood (chronic bullous dermatosis of childhood). Clin Dermatol 1991;9:393-401.
  10. Fortuna G, Marinkovich MP: Linear immunoglobulin A bullous dermatosis. Clin Dermatol 2012;30:38-50.

Article / Publication Details

First-Page Preview
Abstract of Published: July 2015

Published online: July 25, 2015
Issue release date: May – August

Number of Print Pages: 4
Number of Figures: 1
Number of Tables: 0


eISSN: 1662-6567 (Online)

For additional information: https://www.karger.com/CDE

References

  1. Sugi T, Hashimoto T, Hibi T, Nishikawa T: Production of human monoclonal anti-basement membrane zone (BMZ) antibodies from a patient with bullous pemphigoid (BP) by Epstein-Barr virus transformation. Analyses of the heterogeneity of anti-BMZ antibodies in BP sera using them. J Clin Invest 1989;84:1050-1055.
  2. Ishii N, Yoshida M, Hisamatsu Y, Ishida-Yamamoto A, Nakane H, Iizuka H, Tanaka T, Hashimoto T: Epidermolysis bullosa acquisita sera react with distinct epitopes on the NC1 and NC2 domains of type VII collagen: study using immunoblotting of domain-specific recombinant proteins and postembedding immunoelectron microscopy. Br J Dermatol 2004;150:843-851.
  3. Matsumura K, Amagai M, Nishikawa T, Hashimoto T: The majority of bullous pemphigoid and herpes gestationis serum samples react with NC16a domain of the 180-kDa bullous pemphigoid antigen. Arch Dermatol Res 1996;288:507-509.
  4. Nie Z, Hashimoto T: IgA antibodies of cicatricial pemphigoid sera specifically react with C-terminus of BP180. J Invest Dermatol 1999;112:254-255.
  5. Hisamatsu Y, Nishiyama T, Amano S, Matsui C, Ghohestani R, Hashimoto T: Usefulness of immunoblotting using purified laminin 5 in the diagnosis of anti-laminin 5 cicatricial pemphigoid. J Dermatol Sci 2003;33:113-119.
  6. Ishii N, Ohyama B, Yamaguchi Z, Hashimoto T: IgA autoantibodies against the NC16a domain of BP180 but not 120-kDa LAD-1 detected in a patient with linear IgA disease. Br J Dermatol 2008;158:1151-1153.
  7. Jabłońska S: The therapies for linear IgA bullous dermatosis of childhood. Pediatr Dermatol 1999;16:415.
    External Resources
  8. Wojnarowska F: Linear IgA dapsone responsive bullous dermatosis. J R Soc Med 1980;73:371-373.
    External Resources
  9. Jabłońska S, Chorzelski TP, Rosinska D, Maciejowska E: Linear IgA bullous dermatosis of childhood (chronic bullous dermatosis of childhood). Clin Dermatol 1991;9:393-401.
  10. Fortuna G, Marinkovich MP: Linear immunoglobulin A bullous dermatosis. Clin Dermatol 2012;30:38-50.

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