Rituximab for linear immunoglobulin A bullous dermatosis

Rummit Dhillon; Lily Park; Sarah Gabros; Tam Nguyen; Stanley Skopit

doi:10.4081/dr.2023.9574

Linear immunoglobulin A bullous dermatosis (LABD) is an idiopathic or drug-induced vesiculobullous disease typically managed with dapsone or colchicine. We report a case of LABD successfully treated with rituximab in a patient who was intolerant to first-line therapies and recalcitrant to typical immunosuppressants. The patient was initially started on prednisone and mycophenolate mofetil which resulted in minimal response and disease progression. Improvement was seen after two infusions of rituximab 1000 mg at 2 weeks apart with planned maintenance therapy.

Nedosekin D, Wilson KD, Campbell K, Shalin S, Wong HK. Immunologic overlap in a case of linear IgG/IgA bullous dermatosis responsive to rituximab. JAAD Case Rep. 2021;9:57-60. Published 2021 Jan 11. doi:10.1016/j.jdcr.2020.12.029.

Kuechle MK, Stegemeir E, Maynard B, Gibson LE, Leiferman KM, Peters MS. Drug-induced linear IgA bullous dermatosis: report of six cases and review of the literature. J Am Acad Dermatol. 1994;30(2 Pt 1):187-192. doi:10.1016/s0190-9622(94)70015-x.

Fortuna G, Marinkovich MP. Linear immunoglobulin A bullous dermatosis. Clin Dermatol. 2012;30(1):38-50. doi:10.1016/j.clindermatol.2011.03.008.

Bolognia JL, Schaffer JV, Cerroni L, Dermatitis Herpetiformis and Linear IgA Bullous Dermatitis. Hull CM, Zone J, eds. In: Dermatology. 4th ed. Elsevier. 2018; 534.

Kelly SE, Frith PA, Millard PR, Wojnarowska F, Black MM. A clinicopathological study of mucosal involvement in linear IgA disease. Br J Dermatol. 1988;119(2):161-170. doi:10.1111/j.1365-2133.1988.tb03197.x.

Verhelst F, Demedts M, Verschakelen J, Verbeken E, Mariën K, Peeters C. Adult linear IgA bullous dermatosis with bronchial involvement. Br J Dermatol. 1987;116(4):587-590. doi:10.1111/j.1365-2133.1987.tb05884.x.

Bernett CN, Fong M, Yadlapati S, Rosario-Collazo JA. Linear IGA Dermatosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 23, 2022.

Pinard C, Hebert V, Lecuyer M, Sacre L, Joly P. Linear IgA bullous dermatosis treated with rituximab. JAAD Case Rep. 2019;5(2):124-126. Published 2019 Jan 12. doi:10.1016/j.jdcr.2018.11.004.

Kaya İslamoğlu ZG, Akyürek FT. A case of recalcitrant linear IgA bullous dermatosis: Successfully treated with rituximab. Dermatol Ther. 2019;32(3):e12911. doi:10.1111/dth.12911.

Lozinski A, Baum S, Sagi L, Volkov A, Trau H, Barzilai A. Harefuah. 2012;151(10):562-606.

Nedosekin D, Wilson KD, Campbell K, Shalin S, Wong HK. Immunologic overlap in a case of linear IgG/IgA bullous dermatosis responsive to rituximab. JAAD Case Rep. 2021;9:57-60. Published 2021 Jan 11. doi:10.1016/j.jdcr.2020.12.029

Scheinfeld N. A review of rituximab in cutaneous medicine. Dermatol Online J. 2006;12(1):3. Published 2006 Jan 27.

Lamberts A, Euverman HI, Terra JB, Jonkman MF, Horváth B. Effectiveness and Safety of Rituximab in Recalcitrant Pemphigoid Diseases. Front Immunol. 2018;9:248. Published 2018 Feb 19. doi:10.3389/fimmu.2018.00248.

Nguyen KT, Gwinn CC, Vary JC Jr. Rituximab treatment for dermatitis herpetiformis in the setting of type 1 diabetes mellitus, celiac disease, vitiligo, autoimmune hemolytic anemia, and autoimmune thrombocytopenia. JAAD Case Rep. 2020;6(2):122-123. Published 2020 Jan 22. doi:10.1016/j.jdcr.2019.12.007.

Albers LN, Zone JJ, Stoff BK, Feldman RJ. Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis. JAMA Dermatol. 2017;153(3):315-318. doi:10.1001/jamadermatol.2016.4676.

Werth VP, Joly P, Mimouni D, et al. Rituximab versus Mycophenolate Mofetil in Patients with Pemphigus Vulgaris. N Engl J Med. 2021;384(24):2295-2305. doi:10.1056/NEJMoa2028564.

Dhillon, R., Park, L., Gabros, S., Nguyen, T., & Skopit, S. (2022). Rituximab for linear immunoglobulin A bullous dermatosis. Dermatology Reports, 15(2). https://doi.org/10.4081/dr.2023.9574