The clinical evolution of lichen planus pemphigoides

Lichen planus pemphigoides following COVID-19 infection

“…LPP is a rare autoimmune sub-epidermal blistering disease with an estimated prevalence of 1 per 1 million patients, an incidence in the fourth to fifth decade, and no sex predilection, 1 versus a slight female preponderance. 2 Although initially characterized as a type of bullous pemphigoid or lichen planus, evidence suggests it is a distinct disease.…”

“…Although most often idiopathic, LPP has been associated with herbal supplements, angiotensin-converting enzyme inhibitors and hydroymethlglutaryl-CoA reductase inhibitors (statins), 3 hepatitis B infection, and malignancy, specifically colonic adenocarcinoma. 1 The diagnostic gold standard is direct immunofluorescence of perilesional skin, displaying autoantibody deposition along the dermal-epidermal junction, as first reported by Stingl and Hobular in 1975. 5 …”

“…Systemic corticosteroids are accepted as first-line therapy, however despite subsequent LPP remission, there is a 20% recurrence rate. 1 Second-line treatment includes hydroxychloroquine, mycophenolate mofetil, azathioprine, tetracyclines, nicotinamide, dapsone, isotretinoin, or ustekinamab. 6 We chose methotrexate while systemic corticosteroids were tapered over several months, given that therapeutic success has been achieved in both LP and BP with methotrexate.…”