Two cases of subepidermal blistering disease with anti-p200 or 180-kD bullous pemphigoid antigen associated with psoriasis.
We describe two patients with psoriasis vulgaris who subsequently developed a subepidermal blistering disease which disclosed IgG and C3 at the basement membrane zone in direct immunofluorescence. The first case was a 75-year-old Japanese man with herpetiform lesions. Histopathology showed neutrophil infiltration. IgG antibodies bound to the dermal side of the salt-split skin. Immunoblot analysis identified a 200-kD antigen in dermal extracts. The second case was a 70-year-old Japanese man. Histopathology showed eosinophil infiltration. IgG antibodies bound to the epidermal side of salt-split skin. Immunoblot analysis identified a 180-kD bullous pemphigoid (BP) antigen in epidermal extracts. We review the clinical and pathological features of psoriatic patients who presented a subepidermal blistering disease in which antigens were detected by immunoblot analysis; i.e., anti-p200 pemphigoid (14 cases) or BP (12 cases). There were few distinct clinical differences between two diseases. However, neutrophils were predominant in anti-p200 pemphigoid, while eosinophils were predominant in BP. After blister formation, ciclosporin was used effectively in addition to systemic steroids in the treatment of anti-p200 pemphigoid. On the other hand, ciclosporin was not used in the treatment of BP with psoriasis.
Yasuda
H
H
Fukuzumi Skin Clinic, Fukuzumi, Toyohira, Sapporo, Japan. hidemi-yasuda@jcom.home.ne.jp
Tomita
Y
Y
Shibaki
A
A
Hashimoto
T
T
D000368:Aged; D001324:Autoantigens / Q000032:analysis / Q000276:immunology*; D001707:Biopsy, Needle; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D006801:Humans; D015151:Immunoblotting; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D011565:Psoriasis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001324:Autoantigens; D007166:Immunosuppressive Agents