Many reports in the medical literature describe patients with concurrent psoriasis and bullous pemphigoid (BP), but little is known about these patients.
Objective:
To characterize patients with concurrent BP and psoriasis and their disease course.
Methods
We performed a systematic review of the English literature for all documented cases of coexistent BP and psoriasis.
Results
Our search yielded 76 cases meeting inclusion criteria. The male-to-female ratio was 2.3:1. The average age of onset of BP was 65 years. Prior to BP eruption, 38% of the patients had acute worsening of their psoriasis. Ultraviolet radiation therapy was the most cited cause of BP outbreak (25%). The most used systemic treatments for BP outbreak were corticosteroids (45%) and methotrexate (18%).
Conclusion
Patients with BP and psoriasis are clinically distinct. Providers should be aware of the association between these diseases and be able to choose treatments that do not exacerbate either disease.
BloomD.. Psoriasis with superimposed bullous eruption.Med J Rec.1929; 130: 246–8.
2.
GrattanC.E.. Evidence of an association between bullous pemphigoid and psoriasis.Br J Dermatol.1985 Sep; 113(3): 281–3.
3.
ChenY.J.WuC.Y.LinM.W.Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study.Br J Dermatol.2011 Sep; 165(3): 593–9.
4.
KoerberW.A.Jr.PriceN.M.WatsonW.. Coexistent psoriasis and bullous pemphigoid: a report of six cases.Arch Dermatol.1978 Nov; 114(11): 1643–6.
5.
AlbergoR.P.GilgorR.S.. Delayed onset of bullous pemphigoid after PUVA and sunlight treatment of psoriasis.Cutis.1982 Nov; 30(5): 621–4.
6.
GrunwaldM.H.DavidM.FeuermanE.J.. Coexistence of psoriasis vulgaris and bullous diseases.J Am Acad Dermatol.1985 Aug; 13(2 Pt 1): 224–8.
7.
SmithW.D.JonesM.S.StewartT.W.FernandoM.U.. Bullous pemphigoid occurring in psoriatic plaques in association with Hashimoto's thyroiditis.Clin Exp Dermatol.1991 Sep; 16(5): 389–91.
8.
RoederC.DrieschP.V.. Psoriatic erythroderma and bullous pemphigoid treated successfully with acitretin and azathioprine.Eur J Dermatol.1999 Oct-Nov; 9(7): 537–9.
9.
LjubojevicS.PasicA.LipozencicJ.MarinovicB.LoncaricD.. Coexistence of psoriasis and bullous diseases - Review of the literature and report of three cases.Acta Dermatovenerologica Croatica.2000; 8(3): 151–9.
10.
YasudaH.TomitaY.ShibakiA.HashimotoT.. Two cases of subepidermal blistering disease with anti-p200 or 180-kD bullous pemphigoid antigen associated with psoriasis.Dermatology.2004; 209(2): 149–55.
11.
WilczekA.SticherlingM.. Concomitant psoriasis and bullous pemphigoid: coincidence or pathogenic relationship?Int J Dermatol.2006 Nov; 45(11): 1353–7.
12.
YasukawaS.DainichiT.KokubaH.Bullous pemphigoid followed by pustular psoriasis showing Th1, Th2, Treg and Th17 immunological changes.Eur J Dermatol.2009 Jan-Feb; 19(1): 69–71.
13.
OhataC.IshiiN.KogaH.Coexistence of autoimmune bullous diseases (AIBDs) and psoriasis: A series of 145 cases.J Am Acad Dermatol.2015 Jul; 73(1): 50–5.
14.
LanganS.M.SmeethL.HubbardR.FlemingK.M.SmithC.J.P.WestJ.. Bullous pemphigoid and pemphigus vulgaris - Incidence and mortality in the UK: Population based cohort study.BMJ.2008; 337(7662): 160–3.
15.
KagamiS.RizzoH.L.LeeJ.J.KoguchiY.BlauveltA.. Circulating Th17, Th22, and Th1 cells are increased in psoriasis.J Invest Dermatol.2010; 130(5): 1373–83.
16.
De PitáO.FrezzoliniA.CianchiniG.RuffelliM.TeofoliP.PudduP.. T-helper 2 involvement in the pathogenesis of bullous pemphigoid: Role of soluble CD30 (sCD30).Arch Dermatol Res.1997; 289(12): 667–70.
17.
SchmidtE.BastianB.DummerR.TonyH.P.BröckerE.B.ZillikensD.. Detection of elevated levels of IL-4, IL-6, and IL-10 in blister fluid of bullous pemphigoid.Arch Dermatol Res.1996; 288(7): 353–7.
18.
LiL.SujanS.A.YangH.WangW.. Serum immunoglobulins in psoriatic erythroderma.Clin Exp Dermatol.2005; 30(2): 125–7.
19.
ZhangP.ChenH.X.DuanY.Q.Analysis of Th1/Th2 response pattern for erythrodermic psoriasis.J Huazhong Univ Sci Technolog Med Sci.2014 Aug; 34(4): 596–601.
20.
TerakiY.FukudaT.. Pemphigoid nodularis associated with psoriatic erythroderma: successful treatment with suplatast tosilate.Br J Dermatol.2008 Feb; 158(2): 424–6.
21.
KobayashiT.T.ElstonD.M.LibowL.F.David-BajarK.. A case of bullous pemphigoid limited to psoriatic plaques.Cutis.2002 Nov; 70(5): 283–7.
22.
PersonJ.R.RogersR.S.3rd. Bullous pemphigoid and psoriasis: does subclinical bullous pemphigoid exist?Br J Dermatol.1976 Nov; 95(5): 535–40.
AhmedA.R.WinklerN.W.. Psoriasis and bullous pemphigoid.Arch Dermatol.1977 Jun; 113(6): 845.
25.
SaracenoR.CitarellaL.SpalloneG.ChimentiS.. A biological approach in a patient with psoriasis and bullous pemphigoid associated with losartan therapy.Clin Exp Dermatol.2008 Mar; 33(2): 154–5.
26.
Monnier-MurinaK.Du ThanhA.Merlet-AlbranS.GuillotB.DereureO.. Bullous pemphigoid occurring during efalizumab treatment for psoriasis: a paradoxical auto-immune reaction?Dermatology.2009; 219(1): 89–90.
27.
Stausbol-GronB.DeleuranM.Sommer HansenE.KragballeK.. Development of bullous pemphigoid during treatment of psoriasis with adalimumab.Clin Exp Dermatol.2009 Oct; 34(7): e285–6.
28.
KlukJ.GouldingJ.M.BhatJ.FinchT.M.. Drug-induced bullous pemphigoid: cases triggered by intravenous iodine and etanercept.Clin Exp Dermatol.2011 Dec; 36(8): 871–3.
29.
GunayU.GunduzK.ErmertcanA.T.KandilogluA.R.. Coexistence of psoriasis and bullous pemphigoid: remission with low-dose methotrexate.Cutan Ocul Toxicol.2013 Jun; 32(2): 168–9.
30.
NakayamaC.FujitaY.WatanabeM.ShimizuH.. Development of bullous pemphigoid during treatment of psoriatic onycho-pachydermo periostitis with ustekinumab.J Dermatol.2015 Oct; 42(10): 996–8.
31.
CramD.L.FukuyamaK.. Immunohistochemistry of ultraviolet-induced pemphigus and pemphigoid lesions.Arch Dermatol.1972; 106(6): 819–24.
32.
MuramatsuT.YamashinaY.ShiraiT.OhnishiT.. UVB irradiation reduces the expression of pemphigoid antigens in organ-cultured normal human skin.Arch Dermatol Res.1994; 286(3-4): 142–4.
33.
DannoK.TagikawaM.HorioT.. The alterations of keratinocyte surface and basement membrane markers by treatment with 8-methoxypsoralen plus long-wave ultraviolet light.J Invest Dermatol.1983; 80(3): 172–4.
34.
GeorgeP.M.. Bullous pemphigoid possibly induced by psoralen plus ultraviolet A therapy.Photodermatol Photoimmunol Photomed.1996 Oct-Dec; 11(5-6): 185–7.
35.
BarnadasM.A.GilaberteM.PujolR.AgustiM.GelpiC.AlomarA.. Bullous pemphigoid in a patient with psoriasis during the course of PUVA therapy: study by ELISA test.Int J Dermatol.2006 Sep; 45(9): 1089–92.
36.
StoicaL.E.PatrascuV.DascaluR.C.CiureaM.E.. Bullous pemphigoid associated with psoriasis, breast cancer and Parkinson's disease.Curr Health Sci J.2014 Jan; 40(1): 62–6.
37.
MrowietzU.DommS.. Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?J Eur Acad Dermatol Venereol.2013 Aug; 27(8): 1022–5.
38.
GoletzS.HashimotoT.ZillikensD.SchmidtE.. Anti-p200 pemphigoid.J Am Acad Dermatol.2014; 71(1): 185–91.
39.
UjiieH.ShibakiA.NishieW.ShimizuH.. What's new in bullous pemphigoid.J Dermatol.2010; 37(3): 194–204.
40.
ChenK.ShimizuS.MiyakawaS.IshikoA.ShimizuH.HashimotoT.. Coexistence of psoriasis and an unusual IgG-mediated subepidermal bullous dermatosis: Identification of a novel 200-kDa lower lamina lucida target antigen.Br J Dermatol.1996; 134(2): 340–6.
41.
PerlS.RappersbergerK.FodingerD.AneggB.HonigsmannH.OrtelB.. Bullous pemphigoid induced by PUVA therapy.Dermatology.1996; 193(3): 245–7.
42.
IshidaS.TakahashiK.KanaokaM.Case of subepidermal autoimmune bullous disease with psoriasis vulgaris reacting to both BP180 C-terminal domain and laminin gamma-1.J Dermatol.2015 Apr; 42(4): 391–3.
43.
RobinsonJ.K.BaughmanR.D.ProvostT.T.. Bullous pemphigoid induced by PUVA therapy. Is this the aetiology of the acral bullae produced during PUVA treatment?Br J Dermatol.1978 Dec; 99(6): 709–13.
44.
AbelE.A.BennettA.. Bullous pemphigoid. Occurrence in psoriasis treated with psoralens plus long-wave ultraviolet radiation.Arch Dermatol.1979 Aug; 115(8): 988–9.
45.
WallachD.CottenotF.. Erythrodermic bullous pemphigoid or erythrodermic psoriasis and bullous pemphigoid?J Am Acad Dermatol.1982 Dec; 7(6): 800.
46.
HislerB.M.BlumenthalN.C.AronsonP.J.HashimotoK.RudnerE.J.. Bullous pemphigoid in psoriatic lesions.J Am Acad Dermatol.1989 Apr; 20(4): 683–4.
47.
WeberP.J.SalazarJ.E.. Bullous eruption in a psoriatic patient. Bullous pemphigoid and psoriasis.Arch Dermatol.1989 May; 125(5): 690, 693–4.
48.
SaekiH.HayashiN.KomineM.A case of generalized pustular psoriasis followed by bullous disease: an atypical case of bullous pemphigoid or a novel bullous disease?Br J Dermatol.1996 Jan; 134(1): 152–5.
49.
PrimkaEJ3rdCamisaC.. Psoriasis and bullous pemphigoid treated with azathioprine.J Am Acad Dermatol.1998 Jul; 39(1): 121–3.
50.
DenliY.G.UslularC.AcarM.A.Bullous pemphigoid in a psoriatic patient.J Eur Acad Dermatol Venereol.2000 Jul; 14(4): 316–7.
51.
PasicA.LjubojevicS.LipozencicJ.MarinovicB.LoncaricD.. Coexistence of psoriasis vulgaris, bullous pemphigoid and vitiligo: a case report.J Eur Acad Dermatol Venereol.2002 Jul; 16(4): 426–7.
52.
PaulJ.. Bullous pemphigoid in a patient with psoriasis and possible drug reaction: a case report.Conn Med.2004 Nov-Dec; 68(10): 611–5.
53.
WashioH.HaraH.SuzukiH.YoshidaM.HashimotoT.. Bullous pemphigoid on psoriasis lesions after UVA radiation.Acta Derm Venereol.2005; 85(6): 561–3.
54.
BarnadasM.A.GilaberteM.PujolR.AgustiM.GelpiC.AlomarA.. Bullous pemphigoid in a patient with psoriasis during the course of PUVA therapy: study by ELISA test.Int J Dermatol.2006 Sep; 45(9): 1089–92.
55.
LazarczykM.WozniakK.IshiiN.Coexistence of psoriasis and pemphigoid—only a coincidence?Int J Mol Med.2006 Oct; 18(4): 619–23.
56.
YamauchiP.S.LoweN.J.GindiV.. Treatment of coexisting bullous pemphigoid and psoriasis with the tumor necrosis factor antagonist etanercept.J Am Acad Dermatol.2006 Mar; 54(3 Suppl 2): S121–2.
57.
SugitaK.KabashimaK.NishioD.HashimotoT.TokuraY.. Th2 cell fluctuation in association with reciprocal occurrence of bullous pemphigoid and psoriasis vulgaris.J Eur Acad Dermatol Venereol.2007; 21(4): 569–70.
InokumaD.KodamaK.NatsugaK.Autoantibodies against type XVII collagen C-terminal domain in a patient with bullous pemphigoid associated with psoriasis vulgaris.Br J Dermatol.2009 Feb; 160(2): 451–4.
60.
CusanoF.IannazzoneS.S.RiccioG.PiccirilloF.. Coexisting bullous pemphigoid and psoriasis successfully treated with etanercept.Eur J Dermatol.2010 Jul-Aug; 20(4): 520.
61.
DuongT.A.BuffardV.AndreC.Efalizumab-induced bullous pemphigoid.J Am Acad Dermatol.2010 Jan; 62(1): 161–2.
62.
OhataC.IshiiN.KogaH.Coexistence of autoimmune bullous diseases (AIBDs) and psoriasis: A series of 145 cases.J Am Acad Dermatol.2015 Jul; 73(1): 50–5.
63.
RaoR.GuptaA.YunisF.HandettuS.ChandrashekarB.. Coexistence of psoriasis with bullous pemphigoid.Indian Dermatol Online J.2012 May; 3(2): 119–21.
64.
NinM.TokunagaD.IshiiN.KomaiA.HashimotoT.KatohN.. Case of coexisting psoriatic arthritis and bullous pemphigoid improved by etanercept.J Dermatol.2013 Jan; 40(1): 55–6.
65.
IinoY.KanoT.AdachiF.A case of bullous pemphigoid associated with psoriasis vulgaris showing Hailey-Hailey disease-like histopathological changes in regenerated epidermis without genomic mutation in ATP2C1 or ATP2A2 gene.J Eur Acad Dermatol Venereol.2015 Aug; 29(8): 1646–8.
66.
JankowskiM.CzajkowskiR.ScibiorK.SchwartzR.A.. Coexistence of psoriasis vulgaris and vitiligo with bullous pemphigoid: a case report.Int J Dermatol.2014 Jul; 53(7): e359–61.
67.
LiZ.JinP.FengS.WangB.. Treatment of coexisting bullous pemphigoid and psoriasis with tripterygium wilfordii.Chin Med J (Engl).2014; 127(16): 3037.
68.
Marek-JozefowiczL.ScibiorK.CzajkowskiR.. PUVA induced bullous pemphigoid in a patient with psoriasis.Acta Dermatovenerol Croat.2014 Dec; 22(4): 301–4.
69.
SiX.GeL.XinH.CaoW.SunX.LiW.. Erythrodermic psoriasis with bullous pemphigoid: combination treatment with methotrexate and compound glycyrrhizin.Diagn Pathol.2014 May 29;9: 102.
70.
WangT.S.TsaiT.F.. Remission of bullous pemphigoid after rituximab treatment in a psoriasis patient on regular low-dose methotrexate.Acta Derm Venereol.2014 Jan; 94(1): 108–9.
71.
Garrido ColmeneroC.Arias SantiagoS.Blasco MorenteG.Perez LopezI.Aneiros FernandezJ.. Photoletter to the editor: Psoriatic erythroderma associated with bullous pemphigoid: clinical appearance and histopathology.J Dermatol Case Rep.2015 Mar 31;9(1): 23–4.
72.
ImanishiA.TateishiC.ImanishiH.Pemphigoid with antibodies to laminin gamma1, BP180 and BP230, associated with psoriasis vulgaris: Successful disease control with cyclosporin.J Dermatol.2015 Apr; 42(4): 394–7.
73.
NakayamaC.IwataH.HagaN.The different intensity of autoantibody deposits in bullous pemphigoid associated with psoriasis vulgaris.Eur J Dermatol.2015 Feb 1;25(1): 70–1.
74.
OkahashiK.OisoN.IshiiN.Bullous pemphigoid associated with psoriasis: A possible example of an inverse intramolecular epitope-spreading phenomenon.J Dermatol.2015 Apr 22.
