Concurrence of Bullous Pemphigoid and Psoriasis: A Case Report

Suwarsa, Oki; Herlina, Lengga; Sutedja, Endang; Dharmadji, Hartati Purbo; Hindritiani, Reti; Gunawan, Hendra

doi:10.2478/sjdv-2018-0018

Abstract

Bullous pemphigoid (BP) and psoriasis are chronic recurrent inflammatory skin diseases. The pathogenesis of concurrence of BP with psoriasis is still unknown. A 39-year-old male with a five-year history of chronic plaque psoriasis developed itchy large tense bullae on the trunk and upper extremities after he had been receiving narrow band ultraviolet B (NBUVB) therapy over five months. Skin biopsy from bulla on the trunk showed typical histological features of BP. Direct immunofluorescent staining showed deposit of immunoglobulin G and C3 in the basement membrane zone (BMZ) which supported the diagnosis of BP. It has been postulated that the autoimmune process responsible for BP lesions might be induced by ultraviolet light therapy and/or the inflammatory processes that occur in psoriasis.

References

1. Barnadas MA, Gilaberte M, Pujol R, Agustí M, Gelpí C, Alomar A. Bullous pemphigoid in a patient with psoriasis during the course of PUVA therapy: study by ELISA test. Int J Dermatol. 2006;45(9):1089-92.10.1111/j.1365-4632.2004.02517.x
Open DOI Search in Google Scholar Back to article
2. Wang TS, Tsai TF. Remission of bullous pemphigoid after rituximab treatment in a psoriasis patient on regular low dose methotrexate. Acta Derm Venereol. 2014;-94(1):108-9.10.2340/00015555-1619
Search in Google Scholar Back to article
3. James WD, Berger TG, Elston DM, editors. Andrews’ disease of the skin, clinical dermatology. 11th ed. London: Saunders/Elsevier; 2011. p. 455-7.
Search in Google Scholar Back to article
4. Bloom D. Psoriasis with superimposed bullous eruption. Med J Rec. 1929;130:246-8.
Search in Google Scholar Back to article
5. Cvetković Jordanov L, Kandolf Sekulović L, Mijušković Ž, Zolotarevski Z, Zečević R. Concomitant psoriasis and bullous pemphigoid - a case report. Serbian Journal of Dermatology and Venereology. 2014;6(1):30-8.10.2478/sjdv-2014-0003
Search in Google Scholar Back to article
6. Abel EA, Bennett A. Bullous pemphigoid. Occurrence in psoriasis treated with psoralens plus long-wave ultraviolet radiation. Arch Dermatol. 1979;115(8):988-9.10.1001/archderm.1979.04010080052026
Search in Google Scholar Back to article
7. Ohata C, Ishii N, Koga H, Fukuda S, Tateishi C, Tsuruta D, et al. Coexistence of autoimmune bullous diseases (AIBDs) and psoriasis: a series of 145 cases. J Am Acad Dermatol. 2015;73(1):50-5.10.1016/j.jaad.2015.03.016
Search in Google Scholar Back to article
8. Stoica LE, Patrascu V, Dascalu RC, Ciurea ME. Bullous pemphigoid associated with psoriasis, breast cancer and Parkinson’s disease. Curr Heatlh Sci J. 2014;40 (1):62-5.
Search in Google Scholar Back to article
9. Fuertes de Vega I, Iranzo-Fernández P, Mascaró-Galy JM. Bullous pemphigoid: clinical practice guidelines. Actas Dermosifiliogr. 2014;105(4):328-46.10.1016/j.ad.2012.10.022
Search in Google Scholar Back to article
10. Borradori L, Bernard P. Pemphigoid group. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 3rd ed. London: Elsevier; 2012. p. 475-82.
Search in Google Scholar Back to article
11. Kirtschig G, Chow ET, Venning VA, Wojnarowska FT. Acquired subepidermal bullous diseases associated with psoriasis: a clinical, immunopathological and immunogenetic study. Br J Dermatol. 1996;135(5):738-45.10.1111/j.1365-2133.1996.tb03883.x
Search in Google Scholar Back to article
12. Washio H, Hara H, Suzuki H, Yoshida M, Hashimoto T. Bullous pemphigoid on psoriasis lesions after UVA radiation. Acta Derm Venereol. 2005;85(6):561-3.10.1080/00015550510035677
Search in Google Scholar Back to article
13. Rotaru M, Opris A. Update and literature review of treatment and prognosis factors in bullous pemphigoid. acta Medica Transilvanica. 2015;20(2):52-4.
Search in Google Scholar Back to article
14. Culton DA, Liu Z, Diaz LA. Bullous pemphigoid. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012. p. 608-16.
Search in Google Scholar Back to article
15. Jukić IL, Marinović B. Significance of immunofluorescence in the diagnosis of autoimmune bullous dermatoses. Clin Dermatol. 2011;29(4):389-97.10.1016/j.clindermatol.2011.01.008
Open DOI Search in Google Scholar Back to article
16. Gudjonsson JE, Elder JT. Psoriasis. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012. p. 197-231.
Search in Google Scholar Back to article
17. Griffiths CEM, Barker JNWN. Psoriasis. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 8th ed. Wiley-Blackwell; 2010. p. 20.1-54.10.1002/9781444317633.ch20
Search in Google Scholar Back to article
18. Roeder C, Driesch PV. Psoriatic erythroderma and bullous pemphigoid treated successfully with acitretin and azathioprine. Eur J Dermatol.1999;9(7):537-9.
Search in Google Scholar Back to article
19. Lesniewska A, Kalinska-Bienias A, Kowalewski C, Schwartz R, Wozniak K. Development of bullous pemphigoid in a patient with psoriasis and metabolic syndrome. Cutis. 2016;98(3):E19-23.
Search in Google Scholar Back to article
20. Boixeda JP, Soria C, Medina S, Ledo A. Bullous pemphigoid and psoriasis: treatment with cyclosporine. J Am Acad Dermatol. 1991;24(1):152.10.1016/S0190-9622(08)80058-8
Open DOI Search in Google Scholar Back to article
21. Bianchi L, Gatti S, Nini G. Bullous pemphigoid and severe erythrodermic psoriasis: combined low-dose treatment with cyclosporine and systemic steroids. J Am Acad Dermatol. 1992;27(2 Pt 1):278.10.1016/S0190-9622(08)80749-9
Open DOI Search in Google Scholar Back to article
22. Hisler BM, Blumenthal NC, Aronson PJ, Hashimoto K, Rudner EJ. Bullous pemphigoid in psoriatic lesions. J Am Acad Dermatol. 1989;20(4):683-4.10.1016/S0190-9622(89)80147-1
Open DOI Search in Google Scholar Back to article
23. Primka EJ 3rd, Camisa C. Psoriasis and bullous pemphigoid treated with azathioprine. J Am Acad Dermatol. 1998;39(1):121-3.10.1016/S0190-9622(98)70414-1
Open DOI Search in Google Scholar Back to article
24. Nousari HC, Sragovich A, Kimyai-Asadi A, Orlinsky D, Anhalt GJ. Mycophenolate mofetil in autoimmune and inflammatory skin disorders. J Am Acad Dermatol. 1999;40(2 Pt 1):265-8.10.1016/S0190-9622(99)70203-3
Search in Google Scholar Back to article
25. Kobayashi TT, Elston DM, Libow LF, David-Bajar K. A case of bullous pemphigoid limited to psoriatic plaques. Cutis. 2002;70(5):283-7.
Search in Google Scholar Back to article

Concurrence of Bullous Pemphigoid and Psoriasis: A Case Report

Abstract

Paradigm

My account