Sárdy M, Kasperkiewicz M
Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337 München, Deutschland.
Hautarzt. 2013 Jun;64(6):447-55; quiz 456-7. doi: 10.1007/s00105-013-2536-y.
We review the pathogenesis, clinical features, diagnosis, differential diagnosis, and therapy of autoimmune bullous skin diseases of childhood, especially of the most common linear IgA dermatosis. In autoimmune bullous diseases, autoantibodies are formed against different adhesion molecules of the skin. These are not only pathophysiologically relevant, but also serve as basis for diagnosis and follow-up of these diseases. In case an autoimmune bullous disease is suspected, histopathology and immunohistopathology (direct immunofluorescence microscopy) as well as serological tests (indirect immunofluorescence microscopy, ELISA, immunoblot) should be performed. Therapy depends on the diagnosis. In IgA-mediated pathogenesis, dapsone can be successfully used. In IgG-mediated diseases, immunosuppression with corticosteroids and steroid-sparing agents should be initiated, although only local therapy is sufficient to control a self-limiting pemphigus neonatorum. In dermatitis herpetiformis, a life-long gluten-free diet is recommended.
我们回顾了儿童自身免疫性大疱性皮肤病,尤其是最常见的线状IgA皮病的发病机制、临床特征、诊断、鉴别诊断及治疗。在自身免疫性大疱性疾病中,会形成针对皮肤不同黏附分子的自身抗体。这些自身抗体不仅在病理生理上具有相关性,也是这些疾病诊断和随访的基础。若怀疑患有自身免疫性大疱性疾病,应进行组织病理学和免疫组织病理学检查(直接免疫荧光显微镜检查)以及血清学检测(间接免疫荧光显微镜检查、酶联免疫吸附测定、免疫印迹法)。治疗取决于诊断结果。在IgA介导的发病机制中,氨苯砜可成功使用。在IgG介导的疾病中,应开始使用皮质类固醇和类固醇替代药物进行免疫抑制,不过对于自限性新生儿天疱疮,仅局部治疗就足以控制病情。对于疱疹样皮炎,建议终生食用无麸质饮食。