Bullous Pemphigoid in a Patient Treated with UVA-1 Phototherapy for Disseminated Morphea

Abstract

Bullous pemphigoid is an autoimmune disease of the skin characterized by the production of antibodies directed at structures of the basement membrane zone (BMZ) leading to subepidermal blisters. Several causative triggers have been described in the literature, among them UV light. Here, we report on a 73-year-old Caucasian female with disseminated morphea who developed blisters on her extremities after receiving whole-body UVA-1 phototherapy. The initial differential diagnosis of a phototoxic versus photoallergic reaction was ruled out as the lesions continued to spread after discontinuation of phototherapy. Histological and direct immunofluorescence examination showing a subepidermal blister and linear IgG deposits along the BMZ along with detection of circulating anti-BMZ antibodies led to the diagnosis of bullous pemphigoid. Immunosuppressive therapy resulted in regression of all blisters. After ruling out other possible causes, such as neoplasias or drugs, we conclude that UVA-1 has to be regarded as the most likely trigger of the disease.

Coexistence of psoriasis and pemphigoid - only a coincidence?

“…Among anti-psoriatic therapeutics, phototherapy (PUVA) (10)(11)(12)(15)(16)27) and tars (10) are the most common factors suspected for triggering pemphigoid. It is in accordance with well-known observations that ultraviolet radiation is able to induce pemphigoid and to exacerbate course of bullous disease, both in healthy individuals (28) and in patients suffering from other skin disorders (29,30).…”

Atypical presentations of bullous pemphigoid: Clinical and immunopathological aspects

“…Ultraviolet radiation can also induce localized BP [86][87][88][89]. Psoralen ultraviolet A (PUVA) [90], narrowband ultraviolet B phototherapy (NBUVB) and photodynamic therapy (PDT) can induce typical and atypical, localized or generalized forms of BP.…”

Pemphigoid Diseases as a Sign of Active Psoriasis: A Case Report and Brief Review

“…These therapeutic agents could induce BP by changing the antigenic features of the BM of the psoriatic base as well as intact skin in genetically predisposed individuals. In the literature, there are a few reports regarding BP development in patients who received phototherapy against nonpsoriatic dermatosis [11]. Therefore, BP can evolve in any genetically predisposed individual who has been exposed to triggering factors which can alter the antigenic characteristics of BM.…”