Familial benign pemphigus, initially described in Hailey brothers in the 1930s (hence the term Hailey-Hailey disease), is a rare blistering skin disease caused by mutations in the ATP2C1 gene coding for cellular electrolyte transporters that are essential in maintaining cell-to-cell adhesion [1] [2] [3]. The autosomal dominant pattern of inheritance is the reason why family history is the most important risk factor for its development [4] [5] [6] [7]. The onset of symptoms is typically observed during the second, third, and fourth decades of life, although patients of all ages have been reported in the literature [4] [5]. The hallmark of familial benign pemphigus is the recurrent appearance of vesicles, erosions, and plaques in intertriginous areas (in a symmetrical fashion) - the groins, submammary regions, the axillae, and the neck [1] [4] [5] [6] [7]. Skin lesions are painful, often pruritic, and have a foul smell [1]. Furthermore, heat, excessive sweating, friction, trauma, stress, and constrictive clothes have been shown to aggravate symptoms [1] [4] [5] [6]. Nail fragility is an important non-cutaneous finding in these patients [4] [5]. Although the clinical course varies from patient to patient, the lesions heal spontaneously without therapy and recur several times throughout the patient's life [1] [8]. Unfortunately, some patients may experience a significant impairment of their quality of life due to familial benign pemphigus [8].

• Localized Pain

  Tolerance was overall acceptable with local pain during and shortly after irradiation being the main limiting factor. [ncbi.nlm.nih.gov]

• Gingival Ulceration

  The lesions involved neck, sub-mammary and inguinal folds, associated with frequent gingival ulcerations since the age of 36 years. Her mother, aunt and two sisters were also affected by cutaneous lesions only. [medicaljournals.se]

• Blister

  The painful blisters break and sometimes become infected and raw, with new blisters forming over raw skin in a sometimes seemingly unending cycle of outbreaks. [en.wikipedia.org]

  These are crusty blisters that tend to form on your chest, back, and shoulders. They don’t hurt, but they do itch. How is Pemphigus Diagnosed? It can be tricky. That’s because a number of conditions can cause blisters. [webmd.com]

  Blisters can accompany some types of skin rashes and inflammatory conditions, including certain autoimmune diseases. Depending upon the cause of the blisters, blisters may occur singly or in groups. [medicinenet.com]

  Upregulation of P-cadherin may be involved in the pathomechanism of both the autoimmune blistering diseases and the inherited blistering diseases. [thedoctorsdoctor.com]

  Benign familial pemphigus (Hailey-Hailey disease) is a rare relapsing-remitting epidermal blistering disease palliated by a multitude of medical and surgical treatments. There are limited reports of benefit from low-penetration X-rays. [ncbi.nlm.nih.gov]

• Leukonychia

  Electron beam radiotherapy Dermabrasion Glycopyrrolate Afamelanotide Clinical images Images hosted on other servers: Hailey-Hailey in right axilla Hyperpigmented plaques over groin Hailey-Hailey lesions on left groin Figure 2b: Showing longitudinal leukonychia [pathologyoutlines.com]

  Patients with Hailey-Hailey disease may also have nail manifestation called ‘longitudinal leukonychia’ which are longitudinal white bands on the fingernails. [aocd.org]

  In patients with limited or atypical disease, longitudinal leukonychia may serve as a diagnostic clue. [therapeutique-dermatologique.org]

  Longitudinal leukonychia, seen 71% in one study, may help in the diagnosis of HHD. [6] However, this nail finding was not observed in the reported case. [e-ijd.org]

• Palmar Hyperhidrosis

  Efficacy and safety of botulinum toxin type a in the treatment of palmar hyperhidrosis: A double-blind, randomized, placebo-controlled study. Dermatol Surg 2002;28:822-7. 10. Lowe PL, Cerdan-Sanz S, Lowe NJ. [ijdd.in]

The diagnosis of familial benign pemphigus can only be made with a detailed patient history and a meticulous physical examination that provides sufficient data for clinical suspicion of this rare blistering skin disorder. In addition to the assessment of the course and progression of symptoms, patients must be asked about the familial presence of symptoms, which may be the crucial detail in narrowing the differential diagnosis. On the other hand, observing typical cutaneous findings in intertriginous areas and associated symptoms can be quite helpful. One of the key features of familial benign pemphigus is the absence of antibody deposition on immunofluorescence testing [4] [5], the principal method for assessing and stratifying other blistering skin lesions (Pemphigus, Pemphigoid, etc.). For this reason, a histopathological examination of lesions is critical. Generalized suprabasal loss of cellular adhesions (known as acantholysis), resembling a dilapidated brick wall appearance, is the hallmark of familial benign pemphigus [4] [8]. Other notable findings on histology are dyskeratosis and preservation of the dermis [5] [8]. Thus, a combination of clinical criteria, a positive family history, and microscopic examination of the skin comprise the diagnostic workup of this rare, but potentially debilitating skin blistering disease.

• Polyps

  Upper and lower digestive endoscopies showed superficial erosions in the lower oesophagus, no lesion in the gastric or duodenal mucosa, a caecal polyp, and lesions of angiodysplasia in the left colon. [medicaljournals.se]

INTRODUCTION/BACKGROUND: Treatment of benign familial pemphigus or Hailey-Hailey disease (HHD), a rare inherited condition associated with a significant impairment of quality of life, is often challenging and disappointing with frequent relapses and infectious [ncbi.nlm.nih.gov]

Treatment is symptomatic with general measures to prevent friction and Sweat. [ijdd.in]

Systemic treatments Systemic treatments are often used when lesions are refractory to local topical treatments or when the disease is too diffuse to be treated focally ( Table 2 ). [dovepress.com]

After active sites of BFP showed good response to treatment, we treated uninvolved skin of the left axilla to assess the efficacy of prophylactic therapy. results Treatment of affected areas, except biopsy sites, resulted in clearing of active lesions [onlinelibrary.wiley.com]

New treatment options are under study and offer hope for better treatments in the future. [emedicine.medscape.com]

[…] painful blisters and rashes to form on the skin, often in the skin folds The cause of Hailey-Hailey Disease is a genetic defect and the condition is inherited in an autosomal dominant manner A treatment of the condition involves steroid therapy; the prognosis [dovemed.com]

A distinct type of cutaneous B-cell lymphoma with an intermediate prognosis. Dutch Cutaneous Lymphoma Working Group. Arch Dermatol 1996; 132:1304-1308. ‏ الصفحة 267 - Fletcher V, Sagebiel RW. [books.google.com]

Hailey-Hailey disease: the clinical features, response to treatment and prognosis. Br J Dermatol. 1992;126:275-82. [ Links ] 3 Riahi RR, Yamazaki ML, Kelly BC. Tzanck smear utilized in the diagnosis of Hailey-Hailey disease mimicking genital herpes. [scielo.br]

Hailey–Hailey disease: The clinical features, response to treatmentand prognosis. Br J Dermatol. 1992;126:275-82. Ikeda S, Suga Y, Ogawa H. Successful management of Hailey–Hailey disease with potent topical steroid ointment. [ijord.com]

Qualifiers English : BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology [decs.bvs.br]

Etiology Mutations in the ATP2C1 gene (localised to 3q21-q24), encoding a calcium pump, cause the disease by impairing epidermal keratinocyte adhesion. [orpha.net]

[…] which are calcium dependent adherence proteins (cadherins) ( Indian Dermatol Online J 2016;7:147 ) Hailey-Hailey and Darier disease share similar pathogenesis, as opposed to pemphigus vulgaris, in which autoantibodies develop against desmosomal proteins Etiology [pathologyoutlines.com]

(Etiology) Hailey-Hailey Disease is an autosomal dominant genetic condition It is caused by missing one of the two copies of the ATP2C1 gene on chromosome 3, which encodes the protein hSPCA1 Approximately 30% of the cases, are caused by random mutations [dovemed.com]

Note English : 92 Allowable Qualifiers English : BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology [decs.bvs.br]

Summary Epidemiology Prevalence is unknown. Clinical description Skin lesions appear during adolescence or more often at the age of 30-40 years; they are relapsing and recurrent. Lesions can be complicated by heat, rubbing or superinfections. [orpha.net]

Synonyms: familial benign chronic pemphigus, Hailey-Hailey disease Epidemiology and aetiology This is a rare inherited autosomal dominant skin disorder, caused by a genetic mutation in the ATP2C1 gene located on chromosome 3. [ 1 ] Occasionally sporadic [patient.info]

Epidemiology Frequency No precise data are available on the incidence of familial benign pemphigus. Sex Both sexes are affected equally by familial benign pemphigus. [emedicine.medscape.com]

[…] topical antimicrobials Terminology Also called benign familial pemphigus Papular acantholytic dermatosis in genitocrural region may be a localized form of H-H disease Sites Axillae, groin, perianal and inframammary areas Rarely involves other sites Pathophysiology [pathologyoutlines.com]

Pathophysiology Keratinocytes are held together through desmosomes and adherens junctions. These junctions consist of calcium-binding transmembrane glycoproteins, which contribute to cellular adhesion. [emedicine.medscape.com]

Pathophysiology The exact role that these mutations play in the clinical manifestation of Hailey-Hailey disease are not yet clear. [dermatologyadvisor.com]

Trying to prevent bacterial, viral, and fungal infections in the affected areas is also important, and drugs used to treat or prevent these infections are commonly used. [medicinenet.com]

Prevention and treatment of bacterial, viral and fungal infections is also important, and drugs used to treat these infections are commonly used. [therapeutique-dermatologique.org]

Intracutaneous injections of botulinum toxin to inhibit perspiration may be of benefit. [9] Maintaining a healthy weight, avoiding heat and friction of affected areas, and keeping the area clean and dry may help prevent flares. [en.wikipedia.org]

[…] diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology GE genetics HI history IM immunology ME metabolism MI microbiology MO mortality NU nursing PS parasitology PA pathology PP physiopathology PC prevention [decs.bvs.br]

Management and treatment There is no specific treatment, but drying the affected areas is essential as well as employing measures to prevent bacterial, fungal and viral infections. [orpha.net]

1. Hunt R, O'Reilly K, Ralston J, Kamino H, Shupack JL. Familial benign chronic pemphigus (Hailey-Hailey disease). Dermatol Online J. 2010;16(11):14.
2. Durr G, et al. The medial-Golgi ion pump Pmr1 supplies the yeast secretory pathway with Ca2+ and Mn2+ required for glycosylation, sorting, and endoplasmic reticulum-associated protein degradation. Mol Biol Cell. 1998;9:1149.
3. Hakuno M, et al. Dissociation of intra- and extracellular domains of desmosomal cadherins and E-cadherin in Hailey-Hailey disease and Darier's disease. Br J Dermatol. 2000;142:702.
4. Warycha M, Patel R, Meehan S, et al; Familial benign chronic pemphigus (Hailey-Hailey disease). Dermatol Online J. 2009;15(8):15.
5. Tchernev G, Cardoso JC. Familial benign chronic pemphigus (Hailey-Hailey Disease): use of topical immunomodulators as a modern treatment option. Rev Med Chil. 2011;139(5):633-637.
6. Graham PM, Melkonian A, Fivenson D. Familial benign chronic pemphigus (Hailey-Hailey disease) treated with electron beam radiation. JAAD Case Rep. 2016;2(2):159-161.
7. Gisondi P, Sampogna F, Annessi G, Girolomoni G, Abeni D. Severe impairment of quality of life in Hailey-Hailey disease. Acta Derm Venereol. 2005;85(2):132-135.
8. Arora H, Bray FN, Cervantes J, Falto Aizpurua LA. Management of familial benign chronic pemphigus. Clin Cosmet Investig Dermatol. 2016;9:281-290.