The Development of Bullous Pemphigoid in a Known Case of Psoriasis Vulgaris
A case report
Keywords:
Psoriasis, Psoriasis vulgaris, Pemphigoid, Bullous pemphigoid, Linear C3 DepositionAbstract
Introduction: The development of Bullous pemphigoid (BP) in a patient with Psoriasis vulgaris (PV) is rare, as Bullous pemphigoid affects a different age group and its cause is not related to psoriasis. The cause of co-existence between the two diseases is still not clear and requires more reporting and review. Case Presentation: Here, we report a case of a 55-year-old woman with a 22-year history of Psoriasis vulgaris who developed itching and blisters to all four limbs around the scaly plaques of PV. Biopsy of the lesion revealed sub-epidermal bullae and an eosinophilic inflammatory infiltrate. Immunofluorescence microscopy showed linear C3 deposition at the basement membrane zone, and the condition was diagnosed as Bullous pemphigoid. Treatment in such conditions varies among reported cases, and includes methotrexate, cyclosporine, dapsone, azathioprine, and others. In this case, methotrexate was suggested but because patient could not tolerate the course of methotrexate she was started on a combination therapy of cyclosporine 100 mg PO twice daily and tetracycline PO 500 mg PO Q 6 hourly. Both conditions showed significant improvement within 4 weeks. Take-away lesson: As the cause of the concurrence is still unclear, the correct management for such cases still vary. The case report highlighted our experience to benefit dermatologists and physicians, with one therapeutic regimen that can benefit patients who cannot tolerate methotrexate due to its side effects.References
Wojnarowska F, Kirtschig G, Highet AS, Venning VA, Khumalo NP. Guidelines for the management of
bullous pemphigoid. Br J Dermatol. 2002; 147(2): 214–21. doi: 10.1046/j.1365-2133.2002.04835.x. PMID:
Nestle FO, Kaplan DH, Barker J . Mechanisms of Disease Psoriasis. N Engl J Med. 2009; 361: 496–509.
Wilczek A, Sticherling M. Concomitant psoriasis and bullous pemphigoid: coincidence or pathogenic
relationship? Int J Dermatol. 2006; 45(11): 1353–7. doi: 10.1111/j.1365-4632.2006.02861.x.
Bloom D. Psoriasis with superimposed bullous eruption. Med J Rec. 1929; 130: 246.
Saraceno R, Chimenti S. Associated conditions of psoriasis. In: Chimenti S, editor. Psoriasis. Florence:
See- Firenze. 2005; 105-11.
Grunwald MH, David M, Feuerman EJ. Coexistence of psoriasis vulgaris and bullous diseases. J Am Acad
Dermatol. 1985; 13(2): 224–8. doi: 10.1016/S0190-9622(85)70163-6.
Endo Y, Tamura A, Ishikawa O, Miyachi Y, Hashimoto T. Psoriasis vulgaris coexistent with epidermolysis
bullosa acquisita. Br J Dermatol. 1997; 137(5): 783–6. doi: 10.1111/j.1365-2133.1997.tb01119.x. PMID:
Morris SD, Mallipeddi R, Oyama N, Gratian MJ, Harman KE, Bhogal BS, et al. Psoriasis bullosa acquisita.
Clin Exp Dermatol. 2002; 27(8): 665–9. doi: 10.1046/j.1365-2230.2002.01100.x. PMID: 12472542.
Kirtschig G, Chow ETY, Venning VA, Wojnarowska FT. Acquired subepidermal bullous diseases
associated with psoriasis: A clinical, immunopathological and immunogenetic study. Br J Dermatol. 1996;
(5): 738–45. doi: 10.1111/j.1365-2133.1996.tb03883.x. PMID: 8977674.
Perl S, Rappersberger K, Födinger D, Anegg B, Hönigsmann H, Ortel B. Bullous pemphigoid induced by
puva therapy. Dermatology. 1996; 193(3): 245–7. doi: 10.1159/000246255. PMID: 8944349.
George PM. Bullous pemphigoid possibly induced by psoralen plus ultraviolet A therapy. Photodermatol
Photoimmunol Photomed. 1995; 11(5–6): 185–7. doi: 10.1111/j.1600-0781.1995.tb00166.x.
Patterson JW, Ali M, Murray JC, Hazka JA. Bullous Pemphigoid: Occurrence in a Patient with Mycosis
Fungoides Receiving PUVA and Topical Nitrogen Mustard Therapy. Int J Dermatol. 1985; 24(1): 173–6.
doi: 10.1111/j.1365-4362.1985.tb05416.x. PMID: 3888880.
Riyaz N, Nasir N, Bindu V, Sasidharanpillai S. Bullous pemphigoid induced by topical PUVASOL. Indian
Journal of Dermatology, Venereology and Leprology. 2014; 80(4): 363–4. doi: 10.4103/0378- 6323.136936.
Abel EA, Bennett A. Bullous pemphigoid. Occurrence in psoriasis treated with psoralens plus long-wave
ultraviolet radiation. Arch Dermatol. 1979; 115(8): 988. PMID: 380470.
Griffiths CE, Barker JN. Psoriasis. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook
of Dermatology. 8th ed. Oxford: Wiley Blackwell; 2010; 1–20.60. doi: 10.1002/9781444317633.ch20.
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