Woodley David T, Remington Jennifer, Chen Mei
Department of Dermatology, The Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Clin Rev Allergy Immunol. 2007 Oct;33(1-2):78-84. doi: 10.1007/s12016-007-0027-6.
Epidermolysis bullosa acquisita (EBA) is an acquired, autoimmune, mechanobullous disease with clinical features reminiscent of genetic dystrophic epidermolysis bullosa (DEB). EBA patients have skin fragility, blisters, scars, and milia formation. DEB is due to a genetic defect in the gene-encoding type VII collagen, which makes anchoring fibrils, structures that attach the epidermis and its underlying basement membrane zone onto the papillary dermis. DEB patients have a decrease in normally functioning anchoring fibrils. EBA patients have the same problem, but their decrease in normally functioning anchoring fibrils is because of an abnormality in their immune system in which they produce anti-type VII collagen antibodies that attack their anchoring fibrils. These IgG anti-type VII collagen antibodies are "pathogenic" because when injected into a mouse, the mouse develops an EBA-like blistering disease. EBA has several distinct clinical presentations. It can present with features similar to DEB. It can also present with features reminiscent of bullous pemphigoid, cicatricial pemphigoid, Brunsting-Perry pemphigoid, or IgA bullous dermatosis. Treatment for EBA is unsatisfactory. Some therapeutic success has been reported with colchichine, dapsone, photopheresis, infliximab, and IVIG.
获得性大疱性表皮松解症(EBA)是一种获得性自身免疫性机械性大疱病,其临床特征让人联想到遗传性营养不良性大疱性表皮松解症(DEB)。EBA患者有皮肤脆弱、水疱、瘢痕和粟丘疹形成。DEB是由于编码VII型胶原蛋白的基因存在遗传缺陷,该基因产生锚定原纤维,即把表皮及其下方的基底膜带附着到乳头真皮上的结构。DEB患者正常功能的锚定原纤维减少。EBA患者也有同样的问题,但他们正常功能的锚定原纤维减少是因为其免疫系统异常,产生攻击自身锚定原纤维的抗VII型胶原蛋白抗体。这些IgG抗VII型胶原蛋白抗体是“致病性的”,因为将其注射到小鼠体内时,小鼠会患上类似EBA的水疱病。EBA有几种不同的临床表现。它可以表现出与DEB相似的特征。也可以表现出让人联想到大疱性类天疱疮、瘢痕性类天疱疮、布伦斯廷 - 佩里类天疱疮或IgA大疱性皮肤病的特征。EBA的治疗效果并不理想。已报道秋水仙碱、氨苯砜、光分离置换法、英夫利昔单抗和静脉注射免疫球蛋白有一定的治疗成效。