Management of Coexisting Bullous Pemphigoid and Psoriasis: A Review

Hsieh, Chang-Yu; Tsai, Tsen‐Fang

doi:10.1007/s40257-022-00719-7

Cited by 10 publications

(9 citation statements)

References 85 publications

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“…It is well known that systemic corticosteroids indicated for BP ( 38 ), together with tertracyclines may aggravate concomitant psoriasis ( 39 – 42 ). Cytotoxic agents such as methotrexate, azathyoprine, mycophenolate mofetil, and cyclosporin are reasonable alternatives but the latter two might be inaccessible because of their high price ( 43 , 44 ). Dapsone ( 45 ) has been occasionally reported to successfully treat the blistering eruption but with regard to psoriatic lesions it is considered as appropriate in pustular psoriasis mainly ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

2023

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Autoimmune blistering diseases of the skin have all been reported in patients with psoriasis, bullous pemphigoid (BP) being the most frequently observed. The pathophysiologic triggers for BP in psoriatic patients are unclear. Recent observational studies have suggested that chronic psoriatic inflammation may cause pathological changes to the basement membrane zone, thus inducing autoimmunity against BP antigens through cross reactivity and “epitope spreading.” The coexistence of BP and psoriasis poses challenging therapeutic dilemmas related to the incompatibility of their standard treatments. Considering the probable common immunologic mechanisms in the pathogenesis of these inflammatory skin disorders, a suitable treatment regimen should be applied for their parallel control. We report three patients, who developed BP in the course of preceding long-lasting psoriasis. Secukinumab was administered as first-line treatment with promising therapeutic effect for both skin disorders and long-term disease control in two of the cases. In the third case, parallel disease control was initially achieved with methotrexate. A few years later, secukinumab was used for the treatment of a relapse of both dermatoses but worsening of BP was observed and methotrexate was reintroduced. Our experience on the therapeutic potential of secukinumab in BP is supported by the data in the literature. Recently, it was demonstrated that the proinflammatory cytokine IL17A has a functional role in the process of skin inflammation in BP, similarly to psoriasis. IL17A inhibition has emerged as a promising therapeutic strategy in patients with extensive or refractory BP but paradoxical development of BP after secukinumab treatment for psoriasis has also been described. This controversy emphasizes the need for further investigation into the development of optimal treatment strategies and recommendations.

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Section: Discussionmentioning

confidence: 99%

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

2023

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“…1 Bullous pemphigoid is independently associated with psoriasis, and co-management of the two has limited evidence. 2 Here we present two cases of patients with BP and psoriasis who were successfully treated by IL-23 inhibition.…”

Section: Two Patients With Concomitant Bullous Pemphigoid and Psorias...mentioning

confidence: 99%

Two patients with concomitant bullous pemphigoid and psoriasis successfully treated by IL‐23 inhibition

Cole

Amber

2023

Acad Dermatol Venereol

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“…Interestingly, targeting IL17/IL23 demonstrated efficacy in patients with coexisting BP and psoriasis, a prototype of IL17/IL23 driven disease (33,(54)(55)(56)(57). Results from ongoing clinical trials are thereby necessary to understand the impact of this treatment approach also in BP patients without coexisting psoriasis (58). Inhibition of janus kinase may worth being investigated in BP, since this could allow simultaneous targeting of both IL-4 and IL-23 (59)(60)(61)(62).…”

Section: Experimental Evidence Therapeuticsmentioning

confidence: 99%

The cytokine milieu of bullous pemphigoid: Current and novel therapeutic targets

et al. 2023

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Bullous pemphigoid (BP) is the most common autoimmune bullous disease, characterized by severe pruritus and skin blistering. The loss of tolerance against Collagen XVII, also referred to as BP180, is the main pathogenic event of BP, leading to production of IgG autoantibodies which mainly target the juxtamembranous extracellular non-collagenous 16th A (NC16A) domain of BP180. A complex inflammatory network is activated upon autoantibody binding to the basement membrane zone; this inflammatory loop involves the complement cascade and the release of several inflammatory cytokines, chemokines and proteases from keratinocytes, lymphocytes, mast cells and granulocytes. Collectively, these events disrupt the integrity of the dermal-epidermal junction, leading to subepidermal blistering. Recent advances have led to identify novel therapeutic targets for BP, whose management is mainly based on the long-term use of topical and systemic corticosteroids. As an example, targeting type-2 T-helper cell-associated cytokines, such as Interleukin-4 and interleukin-13 has shown meaningful clinical efficacy in case series and studies; targeting IL-17 and IL-23 has also been tried, owing to an important role of these cytokines in the chronic maintenance phase of BP. In this review article, we discuss the complex cytokine milieu that characterized BP inflammation, highlighting molecules, which are currently investigated as present and future therapeutic targets for this life-threatening disease.

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Management of Coexisting Bullous Pemphigoid and Psoriasis: A Review

Cited by 10 publications

References 85 publications

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

Two patients with concomitant bullous pemphigoid and psoriasis successfully treated by IL‐23 inhibition

The cytokine milieu of bullous pemphigoid: Current and novel therapeutic targets

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