Coexistence of Psoriasis vulgaris and Pemphigus foliaceus

Development of pemphigus herpetiformis in a patient with psoriasis receiving UV‐light treatment

“…Recent research results indicate that psoriasis is a disorder of the immune system, with activated T cells triggering the inflammation and hyperproliferation of keratinocytes 8,9 . Former case studies have reported the new onset of pemphigus occurring in patients with a history of psoriasis 10–16 . Others have reported the concurrent development of both of these diseases 17 .…”

A case of pemphigus foliaceus and pustular psoriasis with a brief review of literature

“…Our patient initially had annular lesions on the face which were superimposed by generalized eruptive pustular lesions with systemic symptoms, so we considered the diagnosis of PF and GPP. This association has been explained by multiple hypotheses including: Common pathogenic pathway, common human leukocyte antigen (HLA) type in either diseases, treatment complications or just a simple coincidence [3,[7][8][9].…”

“…• There has been significant decreased suppressor activity in psoriasis disease which results in increasing production of autoantibodies against skin antigens [9] • Plasminogen activator which has a major role in the induction of acantholysis has been increased in psoriatic lesions [8,9] • HLA-DR4 haplotype is a common HLA type in both diseases [8] • IgG autoantibodies could be able to induce Interleukin-8 (IL8) expression in keratinocytes; IL-8 has an important role in the production of neutrophilic pustules [4] • Corticosteroids which have been used for treatment of AIBD could be a trigger for pustular psoriasis [7] on the other hand phototherapy for psoriasis may be a trigger to produce endogenous pemphigus autoantibodies [3,10]; in addition heat and ultra violet (UV) radiation are exacerbating factors in PF [2]. Also interleukin-1 (IL-1) is a proinflammatory cytokine which has a major role in AIBD, psoriasis and UV damage [7] • Enalapril or penicillamin intake, topical dithranol or salicylic acid, transient hypo zincemia and potential infectious foci, all have been incriminated in previous case reports [5,11].…”

Coexistence of Psoriasis and Pemphigus after Enalapril Intake

“…Grunwald et al [2] suggested that this association is a result of decreased suppressor T cell activity, resulting in the formation of autoantibod-ies or immunologic reactions that could be precipitated by endogenous or exogenous factors such as antipsoriatic treatment. Lee and Ro [4] stated that inflammation in psoriasis could have enhanced expression of pemphigus antigens or upregulated immune mechanisms, while Yokoo et al [6] proposed that increased plasminogen activator activity seen in psoriasis may contribute to the pathogenesis of pemphigus, a view that was further supported by Panzarella and Camisa [5].…”

“…Since then, several cases of psoriatic patients who developed bullous diseases, most commonly bullous pemphigoid, have been reported [2][3][4][5][6]. Moreover, medications, especially thiol drugs, have been repeatedly reported to induce pemphigus [7].…”