Concurrence of Bullous Pemphigoid and Psoriasis: A Case Report

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.

UVB-induced bullous pemphigoid in a patient with psoriasis

“…Two of the patients had a previous history of psoriasis: of 5 and 15 years, respectively (Suwarsa et al . [ 9 ] and our patient), whereas the patient of Corey et al . [ 10 ] had a 4 months’ history of psoriasis before the development of BP, which would be consistent with published case-control studies confirming that over one third of BP/psoriasis patients are diagnosed with BP in the first year after psoriasis was confirmed [ 8 ].…”

“…The mechanism of NB-UVB therapy in the development of BP remains unknown. It is suggested that UV radiation may induce the alteration of basement membrane antigenicity by direct epidermal damage and subsequent autoantibody production, which may later cross-react with basement membrane proteins, such as the BP antigen, causing a bullous eruption [ 9 ].…”

“…We compared our patient with two, recently published case reports by Suwarsa et al . [ 9 ] and Corey et al . [ 10 ] of BP development after a course of UVB-NB in psoriatic patients ( Table 1 ).…”

“…Our patient and the patient described by Suwarsa et al . [ 9 ] had the diagnosis of BP confirmed based on DIF. In contrast, the patient described by Corey et al .…”

Goeckerman Regimen as an Effective Treatment Modality for Checkpoint Inhibitor Dermatoses

“…There have been a few case reports and case series regarding the development of bullous disease in psoriasis patients treated with both UVA and UVB phototherapy 5,6,7,8,9 . In a series of 7 patients with psoriasis who subsequently developed pemphigus, 30% had been treated with phototherapy 7 .…”