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

Abstract

Background: Overlap of bullous pemphigoid (BP) with chronic psoriatic plaques (CPP) is a common condition. However, the association of BP with pustular psoriasis (PP) is uncommon. Moreover, perilesional erythema and pustular lesions on CPP are accepted as a sign of unstable psoriasis. Unstable psoriasis could be triggered by certain irritant topical treatments against psoriasis. These chemical agents could also induce a localized pattern of generalized PP. Here, we describe BP and PP collision in unstable CPP. Objective: By this observation we suggest that BP could be a sign of active psoriasis. Presumably, psoriasis-induced BP is an inflammation activity-dependent condition. Methods: This study is a case report and literature review. Results: The dramatic response of bullo-pustular lesions to short-term methotrexate (MTX) treatment suggests the rule of ‘no psoriasis, no BP'. Presumably, MTX supressed the active inflammation of CPP and BP disappeared following CPP control. Conclusion: BP can be a sign of active psoriasis in the present case.

Psoriasis is associated with increased risk of bullous pemphigoid: A nationwide population‐based cohort study in Taiwan

“…Psoriatic inflammation by itself, comorbidities and antigen‐altering factors, such as therapeutic agents, were all previously reported to contribute to the development of BP . Systemic inflammatory responses occur in psoriasis with comorbidities altering the antigenicity of the basement membrane with subsequent autoantibody production and blister formation in BP …”

“…Moreover, psoriatic patients may undertake a broad spectrum of therapies. Several studies on BP development among psoriatic patients report certain trigger factors, such as the application of topical steroids, topical anthralin, coal tar and ultraviolet (UV) radiation . UV light may reduce barrier function and alter the antigenicity of the basement membrane, contributing to blister formation .…”

“…7,14 Systemic inflammatory responses occur in psoriasis with comorbidities altering the antigenicity of the basement membrane with subsequent autoantibody production and blister formation in BP. 5,6,14,15 Moreover, psoriatic patients may undertake a broad spectrum of therapies. Several studies on BP development among psoriatic patients report certain trigger factors, such as the application of topical steroids, topical anthralin, coal tar and ultraviolet (UV) radiation.…”

“…Several studies on BP development among psoriatic patients report certain trigger factors, such as the application of topical steroids, topical anthralin, coal tar and ultraviolet (UV) radiation. 1,2,5,6,16 UV light may reduce barrier function and alter the antigenicity of the basement membrane, contributing to blister formation. 1,14,16 Our study revealed that 20% of cases with coexisting psoriasis and BP have a history of phototherapy that is significantly higher than that in general psoriatic patients (12.8%).…”

“…In 1929, Bloom et al first reported on the coexistence of BP and psoriasis. Since then, it has been described by other sporadic case reports, [1][2][3][4][5][6][7] case series 8 and case-control studies. [9][10][11] In a nationwide population-based case-control study of 3485 patients with BP, psoriasis was found to be significantly associated with BP.…”