Blister Formation Research Articles

Towards Optimized Management of Bullous Myringitis: A 5-Year Cohort Study Evaluating Treatment Efficacies, Surgical Risks, and Topical Interventions in Contemporary Practice

Bullous Myringitis (BM) is a pathological condition characterised by the formation of painful blisters on the tympanic membrane, leading to challenges in its management. The present study investigated the effectiveness of BM treatment, the potential risks associated with surgical interventions, and the efficacy of topical therapy. The study consisted of a retrospective cohort analysis spanning a period of five years, involving a total of 50 patients diagnosed with Bullous Myringitis. The study encompassed an examination of various aspects, including demographics, symptoms, treatments, and outcomes. The efficacy of topical treatments was evaluated through a randomised controlled trial (RCT). The application of linear regression was employed in order to ascertain the predictors of treatment outcomes. The present study investigated the participants' quality of life and the occurrence of complications. The most commonly reported complaint, ear pain, demonstrated the greatest efficacy when treated with topical medication. The randomised controlled trial (RCT) demonstrated that the implementation of topical treatment resulted in a notable amelioration of symptoms and an increase in patient satisfaction. The treatment modality was found to be a significant predictor of positive outcomes, while no significant associations were observed between age and gender and treatment outcomes. The application of topical therapy resulted in a decrease in the occurrence of granular myringitis and a reduction in sensorineural hearing loss. The patients indicated an enhancement in their quality of life subsequent to the intervention. Personalised therapeutic strategies, surgical prudence, and topical therapies play a crucial role in the management of BM. This study presents a comprehensive framework for the implementation of evidence-based procedures related to bowel movements. In order to validate these findings, it is recommended that comprehensive, prospective studies be conducted on a large scale.

Bullous Pemphigus: A Comprehensive Review of a Complex Autoimmune Disease of the Skin and Mucous Membranes

Pemphigus bullosus, also known as pemphigus vulgaris, is a rare and potentially serious autoimmune disease affecting the skin and mucous membranes, characterized by the formation of intraepidermal blisters due to the loss of cellular cohesion at desmosomal junctions. In this article, we present a comprehensive review of the entity, covering its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and therapeutic options. We highlight the complexity and diagnostic challenges associated with bullous pemphigus, emphasizing the importance of careful clinicopathologic and immunofluorescent correlation for its proper identification. We also discuss in detail the multidisciplinary therapeutic approach required to achieve disease control, emphasizing the use of systemic immunosuppressants and biological therapies. In addition, we highlight the relevance of local therapy and care management, along with the need for close medical follow-up to assess response to treatment and minimize adverse effects. Finally, we highlight the importance of continued research in this complex clinical entity, in order to improve the understanding of its immunopathological mechanisms and to develop more specific and personalized therapies. In conclusion, this article provides a comprehensive and updated view of bullous pemphigus, with the aim of improving its clinical management and promoting a more efficient and effective therapeutic approach.

An unusual case of linear IgA disease affecting only the oral gingiva: a case report

BackgroundWe present a case report on desquamative gingivitis diagnosed as linear IgA disease (LAD), which is a rare autoimmune bullous disease exclusively affecting the oral gingiva. The oral mucosa can be impacted by various autoimmune bullous diseases, and our report focuses on this particular manifestation of LAD.Case presentationThis patient presented with atypical symptoms, as frequent blister formation on the gingiva was the primary clinical manifestation. A combination of systemic and local treatment was administered to the patient. Following the treatment, there was a significant improvement observed in both the erythema and the bullous lesions on the gingiva.ConclusionsA more suitable local treatment strategy should be formulated for patients presenting with oral topical lesions, which clinicians can employ effectively.

Characterizing the Adhesion Between Thin Films and Rigid Substrates Using Digital Image Correlation-Informed Inverse Finite Elements and the Blister Test

Abstract Characterizing the adhesion between thin films and rigid substrates is crucial in engineering applications. Still, existing standard methods suffer from issues such as poor reproducibility, difficulties in quantifying adhesion parameters, or overestimation of adhesion strength and fracture energy. Recent studies have shown that the blister test (BT) is a superior method for characterizing adhesion, as it provides a quantifiable measurement of mix-mode fracture energy, and it is highly reproducible. In this paper, we present a novel method to characterize mechanical mix-mode adhesion between thin films and rigid substrates using the BT. Our method combines the full triaxial displacement field obtained through digital image correlation with inverse finite element method simulations using cohesive zone elements. This approach eliminates the need for making any mechanistic or kinematic assumptions of the blister formation and allows the characterization of the full traction-separation law governing the adhesion between the film and the substrate. To demonstrate the efficacy of this methodology, we conducted a case study analyzing the adhesion mechanics of a polymeric pressure-sensitive adhesive on an aluminum substrate. Our results indicate that the proposed technique is a reliable and effective method for characterizing the mix-mode traction-separation law governing the mechanical behavior of the adhesive interface and could have broad applications in the field of materials science and engineering. Also, by providing a comprehensive understanding of the adhesion mechanics between thin films and rigid substrates, our method can aid in the design and optimization of adhesively bonded structures.

Cytokine patterns in the blister fluid and plasma of patients with fracture blisters

BackgroundFracture blister (FB) is a complication of fracture, which damages to the skin integrity and increases the risk of infection. Inflammation plays an important role in the formation and development of FBs, but its specific mechanism is still unclear. The aim of this study was to investigate the patterns and dynamic changes of inflammatory cytokines in fracture blister fluid (FBF) and plasma. Materials and methodsFBF and plasma were collected simultaneously from patients with lower extremity fractures with FBs on the first and fifth day after blisters formation. 92 inflammation-related protein biomarkers were measured in plasma and FBF using Proximity Extension Assay (PEA). We analyzed the cytokine patterns and their dynamic changes in FBF and plasma. Cytokine patterns in plasma from FB patients, fracture without blister patients, and healthy subjects were also analyzed. ResultThe cytokine pattern in FBF and plasma of patients with FBs was different but 11 cytokines were significantly correlated in the two sample types. 23 cytokines were different in plasma across FB patients, fracture without blister patients and healthy subjects. In the analysis of plasma from FB patients and fracture without blister patients, 15 cytokines were significantly different and they may be potential risk factors for the occurrence of FBs. The FBF and plasma showed different cytokine patterns in the early and late stages, with 50 cytokines significantly changed in FBF and 20 cytokines in plasma. ConclusionThe different cytokine patterns in plasma between FB patients and fracture without blisters patients may be the potential factors for the occurrence of blisters. The cytokine patterns in FBF and plasma showed a dynamic change from the inflammatory stage to the proliferative and repair stage, which indicates that FBs may have new clinical importance in addition to being a soft tissue injury.

Detection of a natural antibody targeting the shed ectodomain of BP180 in mice

BackgroundPemphigoid diseases are characterized by subepidermal blister formation accompanied by autoantibodies targeting skin component molecules, such as BP180. It is suggested that an epitope–phenotype correlation exists among autoantibodies recognizing BP180. However, it is unclear which regions of BP180 are likely targets for autoantibodies. ObjectiveTo elucidate the portions of BP180 where antibodies tend to react under the breakdown of immune tolerance. MethodsWe immunized mice with full-length mouse BP180 (mBP180) to produce anti-mBP180 antibodies. Using the immunized mice, hybridoma cells were established to produce anti-mBP180 antibodies. We analyzed the characteristics of the anti-mBP180 antibodies that were produced in terms of epitopes, immunoglobulin subclasses, and somatic hypermutations. ResultsHybridoma cells derived from immunized mice with full-length mBP180 produced antibodies targeting the intracellular domain (IC) and the shed ectodomain (EC) of mBP180. Using the domain-deleted mBP180 recombinant protein, we revealed that monoclonal anti-mBP180 EC antibodies react to neoepitopes on the 13th collagenous region of cleaved mBP180, which corresponds to the epitopes of linear IgA bullous dermatosis antibodies in human BP180. Furthermore, the subclasses of these antibodies could be distinguished by epitope: The subclass of the anti-mBP180 IC monoclonal antibodies was IgG, whereas that of the anti-mBP180 EC antibodies was IgM. Of note, a clone of these IgM mBP180 EC antibodies was a germline antibody without somatic hypermutation, which is also known as a natural antibody. ConclusionThese data suggest that mice potentially have natural antibodies targeting the neoepitopes of cleaved mBP180 EC.

Eosinophil-derived galectin-10 upregulates matrix metalloproteinase expression in bullous pemphigoid blisters

BackgroundBullous pemphigoid (BP) is an autoimmune bullous disease in which abundant eosinophils accumulate in the blisters. Galectin-10 abounds in the cytoplasm of eosinophils and is released as a result of eosinophil extracellular trap cell death (EETosis). ObjectiveTo identify EETosis and the pathological roles of galectin-10 in BP. MethodsEETosis and galectin-10 in BP blisters were confirmed by immunofluorescence and transmission electron microscopy. The concentrations of galectin-10 in serum and blister fluid from BP patients were studied by ELISA. The matrix metalloproteinase (MMP) expression in BP blisters was immunohistochemically compared to that in healthy controls. As an in vitro assay, normal human epidermal keratinocytes (NHEKs) and normal human dermal fibroblasts (NHDFs) were stimulated with galectin-10, followed by MMP expression measurement by real-time PCR and ELISA. The signaling pathways activated by galectin-10 were studied using Western blotting and confirmed by inhibition assays. ResultsGalectin-10-containing eosinophil infiltration and the extracellular deposition of major basic protein were observed in BP blisters. The ultrastructural characteristics of tissue eosinophils indicated piecemeal degranulation and EETosis. In the BP patients, the concentration of galectin-10 was higher in the blister fluid than in the serum. Several types of MMPs were upregulated in BP blisters. Galectin-10 upregulated the production of MMPs through the pathways of p38 MAPK, ERK and JNK in NHEKs and NHDFs. ConclusionIn the BP blisters, the eosinophils underwent EETosis and released galectin-10. Galectin-10 might contribute to BP blister formation through the production of MMPs by keratinocytes and fibroblasts.

Epidermolysis Bullosa-A Kindler Syndrome Case Report and Short Literature Review.

Epidermolysis bullosa (EB) represents a group of rare disorders, genetically determined, characterized by skin fragility, blister formation and erosions due to minimal trauma. Depending on the ultrastructural level of skin cleavage, above or below the basement membrane, epidermolysis bullosa can be classified into four major types: simplex, junctional, dystrophic and Kindler Syndrome. In the junctional form of EB, the cleavage level is at the dermo-epidermal junction and the targeted proteins are laminin, type XVII collagen and integrins. The dystrophic form of EB is characterized by cleavage in the dermal layer, collagen VII being the targeted protein. In Kindler EB, multiple levels of cleavage have been described. The mutated gene is FERMT1. Another classification of this disease refers to phenotypic aspects such as extracutaneous lesions, severity, and distribution. The management of epidermolysis bullosa includes supportive wound treatments as well as nutritional support. We present a case of epidermolysis bullosa presented at birth, in a newborn with no family history of bullous skin conditions. The clinical presentation revealed extensive denuded areas and significant skin fragility as well as mucous and nail involvement. Prenatal diagnosis is very hard to achieve due to increased genetic heterogeneity of the disease. The short-term results were good. The importance of prenatal testing and possibilities of diagnosis are reviewed in this article. EB is a devastating disease. The presented case had a favorable evolution, with good short-term results. Significant morbidity can result from secondary infections of blisters and complications of the extracutaneous manifestations.

Influence of Alkyd Composite Coatings with Polyaniline Doped with Different Organic Acids on the Corrosion of Mild Steel

Composite coatings prepared by mixing 5 wt.% polyaniline with commercial alkyd-based paints were applied on carbon steel. The polyaniline emeraldine chloride salt was prepared by procedure recommended by IUPAC, including deprotonation by ammonia hydroxide, and reprotonation with sulfamic, succinic, citric, and acetic acids with different doping degrees or oxidation states. The steel samples with base and composite coatings were immersed in 3% NaCl and the corrosion current density was determined after 96 h in situ using the ASTM 1,10-phenanthroline method. The samples were also inspected by optical microscopy. It was shown that the composite coatings reduced the possibility of blister formations and delamination. The corrosion current density and the appearance of the corrosion products, whose area was determined by ImageJ software, closely followed the initial oxidation state of the polyaniline. It was also shown that damaged composite coatings with higher degrees of oxidized (doped) polyaniline were more prone to formation of corrosion products. The role of the initial state of the polyaniline is discussed. It is suggested that such behavior could be connected to the oxygen reduction reaction mechanism that proceeds mainly via two electron paths on the polyaniline particles, releasing a much smaller amount of hydroxyl ions, which is responsible for the delamination and blister formation of the commercial coatings.

Herpes zoster vaccination recommendations ofthe group of experts of the Polish Society of Vaccinology,the Polish Society of Family Medicine, the Polish Societyof Dermatology, the Polish Association for the Studyof Pain and the Polish Neurological Society

Shingles is an infectious viral disease, a symptomatic reactivation of latent varicella-zoster virus infection (VZV). Its naturalhistory usually involves formation of blisters on erythematous skin, preceded by pain and encompassing the area of a singledermatome. Most vulnerable populations include individuals over 50 years of age as well as high-risk patients. Seriouscomplications can develop in the course of the disease, with post-shingles neuralgia being the one of the highest clinicalimportance; it develops in as many as 30% of all patients, resulting in considerable suffering and reduction in the qualityof life. The treatment of post-shingles neuralgia is lengthy and frequently inefficient, posing a significant challenge forhealthcare systems. Vaccinations are the most efficient form of protection against shingles and its related complications.Due to the epidemiology of infections and their complications, vaccinations are recommended in all individuals over the ageof 50 as well as in younger adults (18 years or older) with the disease risk factors.

Two cases of cutaneous-type pemphigus vulgaris and a case of pemphigus foliaceus without mucosal involvement despite high anti-desmoglein 3 autoantibody levels.

Pemphigus is an autoimmune blistering disease with two major subtypes, pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Although most patients with PV show oral lesions, cutaneous type PV (C-PV) is a rare subtype clinically characterized by predominant cutaneous involvement with no or subtle mucosal lesions. Patients with PF present with only skin involvement; they do not have mucosal lesions. Serologically, autoantibodies against desmoglein (Dsg) 3 and Dsg1 are observed in C-PV whereas PF is associated with anti-Dsg1 antibodies only. Herein, we describe three cases of pemphigus presenting with predominant skin lesions and no mucosal involvement despite high anti-Dsg 3 autoantibody levels in chemiluminescent enzyme immune assays (CLEIAs). In addition, anti-Dsg 1 autoantibodies were positive in patients 2 and 3, but negative in patient 1 based on CLEIAs. Histological examination of the skin showed suprabasal acantholysis in patients 1 and 2, and blister formation in the upper epidermis in patient 3. Histopathology of the oral membrane in patients 1 and 2 showed subtle acantholysis in the suprabasal layer. Thus, we diagnosed patients 1 and 2 as having cutaneous type PV and patient 3 as having PF. Ethylenediaminetetraacetic acid-treated enzyme-linked immunosorbent assay demonstrated a low proportion of anti-Dsg3 autoantibodies recognizing Ca2+ -dependent epitopes, antibodies against which are thought to be the main contributor to acantholysis. Thus, along with Dsg1 antibodies, weak anti-Dsg3 antibodies could induce acantholysis in the skin, but they are insufficient to induce mucosal lesions.

Epidermolysis Bullosa Simplex Caused by a Rare Homozygous Mutation in the EXPH5 Gene.

Recurrent blister formation in children may be a sign of hereditary epidermolysis bullosa even if no salient family history can be elicited. In a case of a 5-year-old boy with recurrent occasional skin blistering, we diagnosed epidermolysis bullosa simplex and found a causative rare homozygous mutation in EXPH5. Precise molecular genetic analysis is a prerequisite for the accurate diagnosis and adequate counselling of affected families.

Oral Jak Inhibitor Upadacitinib Use in Treatment of Pemphigus Foliaceus

Pemphigus foliaceus (PF) is a rare, blistering autoimmune condition that occurs when desmoglein-1 autoantibodies target and lead to loss of intercellular connections, resulting in blister formation on the skin. Current standard of care consists of highly immunosuppressive therapies such as prednisone, rituximab, and mycophenolate mofetil. A 43-year-old male with new-onset PF was treated with upadacitinib, a JAK inhibitor. He saw resolution of his blisters within 12 weeks of treatment and remains in remission from his PF. Our case demonstrates that JAK inhibition may prove to be an effective strategy in preventing dsg-1-triggered blisters. JAK1 inhibitors also may prove to be a safer, less immunosuppressive alternative to the highly immunosuppressive agents available today. Larger studies will be required to study the drug’s efficacy in others with PF.

Blocking soluble Fas Ligand ameliorates pemphigus: PC111 efficacy in ex-vivo human pemphigus models.

Pemphigus is a life-threatening, chronic, autoimmune bullous disease affecting both the skin and the mucous membranes. Based on the mainstream concept that blister formation occurs upon binding of autoantibodies to their antigen proteins (desmoglein1, DSG1 and desmoglein3, DSG3), current therapies mostly aim to suppress the immune system. To avoid the severe side effects associated with the chronic use of immunosuppressive treatments, we have developed PC111, a fully human monoclonal antibody targeting human Fas ligand (FasL). We have provided a number of in vitro and in vivo evidences showing that soluble FasL induces keratinocyte apoptosis followed by acantholysis. An anti-murine FasL prevents blister formation in the pemphigus neonatal mouse model. To confirm the mechanism of action (MoA) and the efficacy of PC111 in a human pemphigus context, we used the keratinocyte dissociation assay and two independent Human Skin Organ Cultures (HSOC) pemphigus models. PC111 reduced acantholysis in vitro, as shown by the dose-dependent reduction of fragments in the monolayer cultures. In the first HSOC model, normal human skin was subcutaneously injected with a scFv antibody fragment directed against DSG1 and DSG3, resulting in a severe acantholysis (70-100%) after 24 hours. PC111 inhibited blister formation to around 50% of control. In the second model, normal human skin was injected with a mixture of pemphigus patients' autoantibodies resulting in a less severe acantholysis (20-30%). PC111 significantly suppressed blister formation to more than 75% up to 72 hours. These results confirm PC111 MoA and demonstrates the efficacy of the anti-FasL antibody also in a pemphigus setting.

Anti-NC16A IgA from Patients with Linear IgA Bullous Dermatosis Induce Neutrophil-Dependent Subepidermal Blistering in Mice

Linear IgA bullous dermatosis (LABD) is an acquired autoimmune subepidermal blistering skin disease characterized by circulating and tissue-bound IgA autoantibodies that recognize epitopes within the hemidesmosomal protein BP180, including its NC16A domain. Histologically, LABD has long been defined by neutrophil infiltration and dermal-epidermal separation. However, the pathogenic roles of anti-NC16A IgA and neutrophils in LABD, as well as their interactions, have not been thoroughly studied. We show that passive transfer of patient-derived anti-NC16A IgA induce clinical and histologic LABD pathology in humanized NC16A mice that are reconstituted locally or systemically with human neutrophils. The lesional skin of mice exhibits significantly elevated levels of the neutrophil chemoattractants CXCL-1 and CXCL-2. Furthermore, we show significantly increased levels of the neutrophil chemoattractant IL-8 in blister fluids of patients with LABD. This study provides direct evidence that anti-NC16A IgA in patients with LABD are pathogenic and interact with neutrophils to mediate tissue injury and subepidermal blister formation. This study further corroborates the importance of neutrophil-mediated tissue injury in LABD disease physiology and establishes a clinically relevant invivo model system that can be used to systematically dissect the immunopathogenesis of LABD.

Investigation of desorption of hydrogen gas from polymer matrix using thermal desorption analysis and finite element modeling

Polymer materials are used widely as sealing materials and liners in hydrogen storage and transportation infrastructure. During operating conditions, polymers are exposed to high pressure hydrogen gas periodically. When in contact, the hydrogen gas diffuses through the polymer material with ease due to its smaller sized molecules compared to the polymer molecules. In the event of rapid decompression of outside hydrogen gas, the hydrogen molecules within the polymer diffuse out. This process is known as the desorption of polymer and can cause blisters or cracking causing permanent damage to the polymer. Here, we used a combined experimental and modeling approach to investigate the desorption of the hydrogen gas in the polymer. Thermal desorption analysis (TDA) experiments were performed on the polymer sample exposed to the high-pressure hydrogen gas to measure the diffusion coefficient and equilibrium hydrogen concentration. Experiments also provided the quantity of hydrogen within the polymer during the desorption process which followed Fick’s law. However, for higher pressurization values, some anomaly was observed in the quantity of hydrogen remaining in the polymer sample. A continuum mechanics based coupled diffusion–deformation-damage model was deployed to simulate the gas desorption process in the material using the finite element method to understand its effect on the material. It was found that the anomaly in TDA results were due to the blister formation on the polymer surface which resulted in longer hydrogen retention. Simulations also showed that blister formation can be affected by multiple parameters such as the addition of filler particles, and pre-existing cavity size.

Management of Herpes zoster in Ayurveda through Bloodletting therapy along with other Ayurveda treatment: A case study

Herpes zoster is a very painful disease. Generally, it is a unilateral and self-limiting condition. Inappropriate or delayed therapy might make the disease worse and increase the risk of complications such as post-herpetic neuralgia. Age-related immunosuppression and low immunity make people more susceptible to herpes infection and more likely to develop post-herpetic neuralgia (15%). According to Ayurveda, it correlates with visarpa. It is a raktapradoshaj vikara (disease caused by vitiated blood) and primarily a pitta-predominant disease manifesting twaka (skin) so visarpa is one of the major skin diseases. Here we present a case of a 66-year-old female patient with k/c/o HTN and hypothyroidism visited the OPD with symptoms of unilateral onset of blisters on the right side of the back region, the right axillary region, and the medial aspect of the right arm, within 48 hours; along with burning Pain, itching, and sleeplessness due to burning. According to Ayurveda, the patient was clinically diagnosed with pittaj visarpa. Considering pitta dosha and rakta dhatu dusti, raktmokshan was planned as the prime treatment. The patient showed improvement in burning pain after the first setting of raktamokshan. The numeric rating scale revealed that the patient experienced relief in the severity of burning pain (from 8 to 0) and itching (from 5 to 0). Other Ayurveda treatments like pittaghna chikitsa (pitta pacifying) and pradeha (local application) were used. Rapid blister formation stopped within three days of treatment, and after 28 days, all blisters crusted off and a normal skin complexion was achieved. Thus, Ayurvedic treatment was valuable and cost-effective for treating conditions like herpes. Ayurveda protects patient’s immune systems and reduces the chances of post herpetic neuralgia and reinfection.

BG04 Oleogel-S10 (birch triterpenes) in the treatment of epidermolysis bullosa wounds: 24-month efficacy and safety data from the EASE study

Abstract Epidermolysis bullosa (EB) is a rare debilitating disorder characterized by skin fragility, blister formation and impaired wound healing. The abnormal wound healing seen in EB is a key driver for systemic disease and can lead to serious clinical complications, deformities and symptoms with a devastating impact on quality of life (QoL). The 90-day double-blind phase (DBP) of the phase III EASE study previously demonstrated accelerated wound healing for oleogel-S10 (birch triterpenes) vs. control gel in EB. Here, we report the safety and total wound burden results from the 24-month open-label phase (OLP), in which all patients received treatment with oleogel-S10. EB Disease Activity and Scarring Index (EBDASI) and body surface area percentage (BSAP) data are reported without visit windows to reflect a real-world situation more accurately, particularly considering the COVID-19 pandemic. The patient population was made up of those with dystrophic EB (n = 178; 86.8%) and junctional EB (n = 25; 12.2%). Further baseline characteristics are available in Table 1. In total, 141 patients (68.8%) completed the OLP. The mean (SD) treatment duration for all patients was 584.7 (246.1) days. Adverse events were reported in 77.1% of all patients in the OLP vs. 81.7% of those receiving oleogel-S10 in the DBP. Mean BSAP for patients treated with oleogel-S10 in the DBP reduced from 12.1% at study entry to 6.1% on completion of the EASE study. Similarly, the mean EBDASI skin activity score in the oleogel-S10 group improved from 19.6 to 15.1 at the end of the OLP. In addition, reductions in both BSAP and EBDASI from OLP baseline were observed in patients who transitioned from control gel to oleogel-S10 in the OLP. Oleogel-S10 has a reassuring long-term safety profile. Furthermore, the long-term impact of accelerated wound healing is evident through the sustained reduction in wound burden over time. This is encouraging given the regular reoccurrence of patients’ fragile wounds in the natural course of this chronic disease. Table 1Baseline characteristics

Eosinophils, Basophils, and Neutrophils in Bullous Pemphigoid.

Bullous pemphigoid (BP) is an autoimmune blistering skin disease, of which the incidence has increased in recent years. BP is characterized by circulating IgG and IgE autoantibodies against the hemidesmosomal proteins BP180 and BP230. Although autoantibodies trigger inflammatory cascades that lead to blister formation, effector cells and cell-mediated autoimmunity must also be considered as important factors in the pathogenesis of BP. The aim of this review is to outline the current knowledge on the role of eosinophils, basophils, and neutrophils in BP.

Ocular mucous membrane pemphigoid

Mucous membrane pemphigoid refers to aheterogeneous group of autoimmune diseases with subepidermal blister formation that can affect all mucous membranes with varying frequencies. This is a rare disease without any geographic or sexual predisposition that is characterized by recurrent inflammation and progressive scarring. The specific diagnostics can be negative in up to 50% of cases. The diagnosis is predominantly made in patients aged 60-80years. Ophthalmologists play an important role in the care of affected individuals as the conjunctiva is the second most frequent site of involvement. The treatment is often tedious and primarily consists of long-term systemic immunosuppression.