4.7 Review

The Intriguing Links between Psoriasis and Bullous Pemphigoid

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Successful secukinumab treatment of active bullous pemphigoid and chronic severe psoriasis: a case report

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Summary: This case report demonstrates the first case of secukinumab achieving a dramatic clinical improvement of both chronic psoriasis and active BP.

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Guselkumab-associated bullous pemphigoid in a psoriasis patient: A case report and review of the literature

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Summary: Drug-induced bullous pemphigoid (DBP) associated with biologics for psoriasis is rare and may spontaneously regress after discontinuation of the triggering drug, responding rapidly to steroid therapy. Despite being a rare side effect, it is important to document and address the increasing side effects of biologic therapies as new molecules are constantly being developed and administered to psoriatic patients.

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Biologic treatment outcomes in mucous membrane pemphigoid: A systematic review

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Bullous pemphigoid: An immune disorder related to aging

Maria Ludovica Deotto et al.

Summary: Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease caused by autoantibodies attacking two principal antigens. The pathogenesis of BP involves genetic predisposition, skin changes due to aging, and specific triggers. Recognition of triggering factors and comorbidities is important for understanding and managing BP. Treatment strategies should focus on restoring skin barrier integrity and maintaining skin homeostasis, particularly in the elderly.

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Overlapping Features of Psoriasis and Atopic Dermatitis: From Genetics to Immunopathogenesis to Phenotypes

Ya-Chu Tsai et al.

Summary: Psoriasis and atopic dermatitis are now considered to be a spectrum of disease, with overlapping genetic loci and immunopathogenesis. The clinical presentations also have similarities.

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Systemic glucocorticoid use and the occurrence of flares in psoriatic arthritis and psoriasis: a systematic review

Nanette L. A. Vincken et al.

Summary: While systemic glucocorticoids (SGC) are traditionally discouraged in the treatment of psoriatic arthritis (PsA) and psoriasis, they are frequently prescribed for these patients. However, studies show that the occurrence of psoriatic flares appears to be low upon SGC exposure. In patients with a clear indication for SGC, consideration should be given to the low risk of skin flaring, while also weighing the risks of short- and long-term SGC-related side effects.

RHEUMATOLOGY (2022)

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Bullous Pemphigoid in Patients Receiving Immune-Checkpoint Inhibitors and Psoriatic Patients-Focus on Clinical and Histopathological Variation

Dennis Niebel et al.

Summary: This study aimed to analyze the clinical and histopathological differences between patients with bullous pemphigoid (BP) who also have psoriasis or receive immune-checkpoint blockade (ICB) therapy and patients with idiopathic BP. The study found that ICB-associated BP affects men more often and might show mucosal involvement more frequently. However, there were no statistically significant dermatopathological differences among the different groups.

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Management of Coexisting Bullous Pemphigoid and Psoriasis: A Review

Chang-Yu Hsieh et al.

Summary: Psoriasis and bullous pemphigoid often coexist and have different optimal treatment strategies. Topical corticosteroids are commonly used for mild cases, while systemic immunosuppressants such as corticosteroids and methotrexate are popular choices for more severe cases. However, tapering of immunosuppressants may lead to flare-ups of both diseases.

AMERICAN JOURNAL OF CLINICAL DERMATOLOGY (2022)

Article Dermatology

Concurrent bullous pemphigoid and plaque psoriasis successfully treated with Janus kinase inhibitor Baricitinib

Yue Xiao et al.

Summary: This case report describes a successful treatment of a Chinese man with concurrent plaque psoriasis and bullous pemphigoid using the Janus kinase inhibitor Baricitinib. Significant improvement in skin lesions and pruritus was observed, and complete remission was achieved without any adverse effects at the 24-week follow-up.

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Bullous pemphigoid induced by biologic drugs in psoriasis: a systematic review

Husein Husein-ElAhmed et al.

Summary: This study accurately estimates the burden of BIBP, with ustekinumab presenting the most evidence of BIBP. Different cytokine pathways and clinical course patterns exist between BPs induced by TNF-alpha blockers and ustekinumab. Prior to commencing any biologic therapy, a careful screening of previous history of bullous diseases and baseline immunologic study in psoriatic patients is advisable.

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Norihito Fukada et al.

JOURNAL OF DERMATOLOGY (2022)

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Updated S2 K guidelines for the management of bullous pemphigoid initiated by the European Academy of Dermatology and Venereology (EADV)

L. Borradori et al.

Summary: The background provides detailed information about bullous pemphigoid (BP) and its impact on patients. The objective of the study is to update the guidelines for managing this disease. The results suggest that treatment should be tailored based on the severity of BP and patients' comorbidities. High-potency topical corticosteroids are recommended as the main treatment, while the use of doxycycline and dapsone is controversial. B-cell-depleting therapy and intravenous immunoglobulins can be considered in treatment-resistant cases. The final version of the guideline received consent from several patient organizations.

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY (2022)

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Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

Peng Cao et al.

Summary: Rituximab, omalizumab, and dupilumab have similar clinical benefits for patients with bullous pemphigoid, but rituximab leads to higher recurrence rates, adverse events, and mortality rates.

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Fumi Miyagawa

Summary: Targeted biologic agents have had a significant impact on the treatment of immune-mediated inflammatory diseases. While they can greatly improve clinical symptoms, they also come with adverse reactions, including paradoxical reactions. Their efficacy in targeting specific cytokines and the presence of paradoxical reactions have helped researchers understand the underlying molecular pathways of these diseases.

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Bullous Pemphigoid Associated with Erythrodermic Psoriasis: A Case Report

Wenjuan Chen et al.

Summary: This case report presents a rare occurrence of bullous pemphigoid (BP) in a woman with severe erythrodermic psoriasis (EP), possibly triggered by beta hemolytic streptococcus infection. This highlights the need for physicians to be attentive to the complicated condition of such patients and further study for better treatment.

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Bullous pemphigoid induced by ustekinumab: a case report

Marta Marin et al.

Summary: A case of possible bullous pemphigoid (BP) associated with ustekinumab treatment was reported in a 75-year-old woman. The patient presented with new lesions shortly after receiving the fifth dose, which resolved with corticosteroid and dapsone treatment. Three causality algorithms suggested a probable causal relationship, highlighting the importance of considering drug side effects in prescribing therapies.

EUROPEAN JOURNAL OF HOSPITAL PHARMACY (2021)

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Role of regulatory T cells in psoriasis pathogenesis and treatment

L. Nussbaum et al.

Summary: Psoriasis is a chronic inflammatory disease with a strong genetic component that can be triggered by environmental factors. Tregs play a fundamental role in immune homeostasis and contribute to the prevention of autoimmune disease by suppressing immune responses, but their functional regulation remains unclear in the context of psoriasis.

BRITISH JOURNAL OF DERMATOLOGY (2021)

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Patients with bullous pemphigoid and comorbid psoriasis present with less blisters and lower serum levels of anti-BP180 autoantibodies

S. Staender et al.

Summary: Patients with both BP and psoriasis present at a younger age with a milder disease phenotype, lower levels of pathogenic autoantibodies, and specific linear C3 deposits along the dermal-epidermal junction detected by direct immunofluorescence microscopy.

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY (2021)

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Could basement membrane alterations, resembling micro-wounds at the dermo-epidermal junction in psoriatic non-lesional skin, make the skin susceptible to lesion formation?

Renata Bozo et al.

Summary: The tissue microenvironment plays a crucial role in regulating immune functions. Studying the constitutively abnormal functions of clinically uninvolved psoriatic skin can provide insights into psoriasis pathobiology. Abnormalities at the dermal-epidermal junction region in non-lesional skin may contribute to the development of the disease.

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Anna R. F. Gregoire et al.

Summary: This study found that the rate of psoriasis flares in adult patients with a known history of psoriasis during or within 3 months after concluding systemic corticosteroid administration was very low, especially for severe flares. The results suggest that systemic steroids may be much less likely to trigger severe flares in patients with psoriasis.

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Christopher E M Griffiths et al.

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Pustular Psoriasis: From Pathophysiology to Treatment

Giovanni Genovese et al.

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A blistering new era for bullous pemphigoid: A scoping review of current therapies, ongoing clinical trials, and future directions

Subaina Naeem Khalid et al.

Summary: Bullous pemphigoid (BP) is a severe autoimmune blistering skin disorder that primarily affects the older population, with increasing prevalence. Current treatment modalities include corticosteroids, non-immunosuppressive agents, and immunosuppressants, but they are often associated with toxicities and high recurrence rates. Efforts are being made to develop newer targeted therapies to provide safer alternatives.

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Psoriasis as an adverse reaction to biologic agents beyond anti-TNF-α therapy

Anastasios Karamanakos et al.

Summary: The study reviewed published cases of induced or exacerbated psoriasis after biologic therapy other than anti-TNF-alpha agents, finding cases of paradoxical psoriasis after ustekinumab and secukinumab treatment, which are approved therapies for psoriasis. Awareness among physicians regarding early recognition of paradoxical psoriasis is crucial.

EUROPEAN JOURNAL OF DERMATOLOGY (2021)

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The Defect in Regulatory T Cells in Psoriasis and Therapeutic Approaches

Naoko Kanda et al.

Summary: Psoriasis is characterized by an imbalance in CD4(+)CD25(+)Foxp3(+) regulatory T cells (Tregs) and alterations in gut microbiota. Therapeutic agents targeting Tregs, such as anti-IL-23 or anti-IL-17A antibodies, retinoids, and probiotics/prebiotics, show promise in restoring Treg function and alleviating psoriasis symptoms.

JOURNAL OF CLINICAL MEDICINE (2021)

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Molecular Pathogenesis of Psoriasis and Biomarkers Reflecting Disease Activity

Masaru Honma et al.

Summary: Psoriasis is a chronic inflammatory skin disease with bothersome symptoms, but recent advances in molecular-targeted therapies have shown promising clinical effects in treating severe symptoms and related skin diseases. Biomarkers such as cytokines, chemokines play a crucial role in defining therapeutic strategies, and blood protein markers show great potential in daily clinical practice.

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The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications

Rohan Singh et al.

Summary: Psoriasis is a chronic, systemic inflammatory disease caused by uncontrolled keratinocyte proliferation and immune system dysregulation. Biological therapies targeting cytokine-mediated pathogenesis have shown improvement in patient quality of life. Approved biological therapies target cytokines TNF-alpha, IL-17, and IL-23 for the treatment of moderate to severe psoriasis.

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Dorota Purzycka-Bohdan et al.

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Matthew J. Verheyden et al.

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