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Direct diagnosis of mucous membrane pemphigoid (MMP) is not easy. Circulating autoantibodies targeting bullous pemphigoid antigens of 180 kDa and 230 kDa (BP180 and BP230), α6β4 integrin, laminin 332 and type VII collagen (Col VII) are not always present. The aims of this study were to characterize the humoral immune response of a cohort of Italian patients with MMP, its association with clinical involvement and severity, and to design an algorithm for efficient serological diagnosis. Seventy-eight MMP sera were studied retrospectively by indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay (ELISA) and immuno-blotting. Indirect immunofluorescence on salt-split skin resulted in the most sensitive approach for diagnosis of MMP. BP180 was the major autoantigen in MMP patients with oral and cutaneous involvement. Significant associations were found between BP180 reactivity and oral and cutaneous localization of the lesions (p = 0.006), and between Col VII positivity and Setterfield severity score (p = 0.020). [ABSTRACT FROM AUTHOR]

The article describes the case of homozygous twins with the first, a 47-year-old verweight male patient with a history of psoriasis and who received the ustekinumab human monoclonal antibody. The variables considered include the presence of the human leukocyte antigen (HLA)-Cw602 allele, the response of the twins to ustekinumab and their personal life profiles. A discussion on the immune response of the first twin is offered.

The article presents case studies of 71-year-old and 53-year-old men with psoriatic arthritis. These cases describe the cutaneous adverse events in patients receiving treatment with tumour necrosis factor (TNF)-alpha blocking agents. They show the atypical lichenoid drug eruptions with interface dermatitis histology that occurred during therapy for psoriasis and psoriatic arthritis with the TNF-alpha blocking agents infliximab and etanercept.