Development of Bullous Pemphigoid in a Patient With Psoriasis and Metabolic Syndrome
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease that most commonly affects adults older than 60 years, whereas psoriasis vulgaris (PV) is a chronic immune-mediated disease that affects both children and adults. Bullous pemphigoid and PV may coexist with each other as well as with various other internal disorders, which may lead to early death. We report the case of a 35-year-old man with a 15-year history of PV and obesity who developed tense blisters with annular arrangement and normal-appearing perilesional skin localized mainly on the trunk, arms, and legs resembling linear IgA bullous dermatosis. This case demonstrated the development of BP in a patient with chronic PV and metabolic syndrome. Although the nature of this unique coincidence is not clear, methotrexate (MTX) seems to be first-line regimen for such cases.
Practice Points
- Metabolic syndrome and psoriasis vulgaris (PV) may promote development of bullous pemphigoid (BP) in patients younger than 60 years.
- Methotrexate may be a therapeutic solution for BP coexisting with PV and metabolic syndrome.
Conclusion
We present a case of concomitant BP and PV in a patient with metabolic syndrome. Although the pathogenic role of this unique coexistence is not fully understood, MTX proved suitable and effective in this single case. Further studies should be performed to elucidate the pathogenic relationship and therapeutic solutions for cases with coexisting PV, BP, and metabolic syndrome.
