M. Hailey-Hailey: hSPCA1 Expression and Skin Structure Upon Laser Therapy

Maastricht University Medical Center11 enrolled

Overview

Hailey-Hailey disease is a genetic acantholytic dermatosis characterized by continuous erosion of the skin that results in a burning, painful sensation and restricts the patient in daily life. This disorder results from a genetic defect in a calcium pump, i.e. the hSPCA1 pump. Calcium pumps are crucial for the processing of cell-cell adhesion proteins such as E-cadherin, part of desmosomes, the major glue between keratinocytes in skin epidermis. Today therapy is mainly focussed on symptom relief and prevention of secondary infection. Ablative laser therapy is known to result in a speedy healing of the affected skin site within 2 weeks following laser therapy. The fact that the treated skin site remains clear from this acantholytic disorder in the months/years following ablation, regardless the existence of a germline mutation, suggests that an epigenetic modification occurs in the process of wound healing. Objective: to (1) study the expression of hSPCA1 in keratinocytes before and after laser therapy and (2) verify the loss of acantholysis by immunohistochemistry and electron microscopy of cell-cell adhesions before and after laser therapy

Study Type

INTERVENTIONAL

Allocation

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Hailey Hailey Disease

Interventions

Skin biopsyPROCEDURE

Skin biopsy: Tissue samples will be taken by punch biopsy according to the daily routine of the Department of Dermatology of the Maastricht UMC+. Steps: * Skin desinfection with chlorhexidine digluconate 1% solution * Local anaesthesia with lidocaine hydrochloride 1% * Biopsy specimens are taken with sterile punch device (disposable biopsy punch delivered by kai medical) * Biopsy specimens are retrieved with sterile pincer and cut with sterile blade * Wound is stitched with a single transcutaneous stich using absorbable suture (vicryl 4.0). * Wound will be treated with R/ fusidic acid ointment 3 to 5 times per day for two weeks * In the first week after laser therapy the wound will be covered by R/ Urgotull non-adhesive gauze, R/ Cutisoft cotton non-sterile gauze and R/ Klinipress exsupad absorbing bandage.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

1.Inclusion criteria 1.1.Hailey-Hailey patients Inclusion Criteria: * Clinically diagnosed M. Hailey-Hailey as confirmed by histopathology and/or genetic analysis. * Indication for ablative laser therapy * \>18 years old * Informed consent 1.2. Patients without Hailey-Hailey disease * \>18 years old * Clinically no symptoms of M. Hailey-Hailey * Informed consent Exclusion Criteria: * \<18 years old * Treatment with tetracyclines, topical hormones or oral retinoids within the last 30 days preceding participation * Lack of informed consent

Outcomes

Primary Outcomes

hSPCA1 expression

Expression of the hSPCA1 calcium pump in keratinocytes before ablative treatment

Time frame: Assessed at time point 0 weeks

hSPCA1 expression

Expression of the hSPCA1 calcium pump in keratinocytes after ablative treatment

Time frame: Assessed 6 weeks after ablative treatment

Secondary Outcomes

Ultrastructure of the skin before and after ablative treatment by electron microscopy and comparison to clinically uninvolved skin and skin of patients without Hailey-Hailey disease.

Cell-to-cell adhesion and desmosome ultrastructure before and after ablative treatment by electron microscopy and comparison to clinically uninvolved skin and skin of patients without Hailey-Hailey disease.

Time frame: At 0 weeks and 6 weeks after ablative therapy

Expression and localization of desmosomal proteins before and after ablative therapy by immunofluorescence.