Oesophageal involvement in epidermolysis bullosa acquisita

reduced levels of the anti-inflammatory oestrogen receptor-a ligand oestrone was found in patients with AD. DHEA is a precursor of testosterone; the level of DHEA is lower in DM, while its metabolite, DHEAS, is lower in DM and DF. Decreased levels of DHEAS have previously been found in atopic allergy and chronic urticaria. Increased levels of DHEAS have been found in patients with acne, and impaired sebum secretion may be the outcome of this decrease in DHEAS levels and may even contribute to the AD phenotype. Furthermore, the application of DHEA(S) affects the production and secretion of T helper (Th)1 and Th2 cytokines, showing an immunomodulatory effect during allergic sensitization and allergic responses. The sulfonation of DHEA is mediated by dehydroepiandrosterone sulfotransferase (SULT2B1), which is a direct vitamin D receptor target, thereby suggesting reduced vitamin D signalling during atopy. We conclude that altered steroid levels in the plasma of patients with AD indicate altered vitamin D signalling (based on reduced DHEA sulfonation) and increased feedback for anti-inflammatory signalling (increased levels of cortisone) present in patients with AD.