Vesiculobullous eruption in a patient receiving psoralen ultraviolet A (PUVA) treatment for prurigo nodules: a case of PUVA-aggravated pemphigoid nodularis

Amber, Kyle T.; Korta, Dorota Z.; Feraudy, Sébastien de; Grando, S. A.

doi:10.1111/ced.13172

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…Identifying an underlying cause, if present, is essential to properly treating a patient with PN to prevent any recurrent pruritus that may lead to recurrence, as well as to avoid any treatments which may be contraindicated. We reported a patient who had received PUVA empirically for treatment of clinically diagnosed PN 11. After several treatments, the patient developed a bullous eruption with workup confirming a diagnosis of pemphigoid nodularis, a variant of bullous pemphigoid.…”

Section: Treatment Of Pnmentioning

confidence: 88%

“…In an effort to simplify terminology, it was recently proposed to utilize chronic prurigo as an all-encompassing clinical term for the various subtypes (nodular, papular, umbilicated) of prurigo based on the unifying core symptoms of CP (>6 weeks), signs of repeated scratching, and the development of pruriginous lesions 10. Still, cases such as pemphigoid nodularis, where the underlying disease requires a significantly different treatment regimen, complicate utilization of such terminology 11. As such, we will make distinctions between treating prurigo and addressing underlying causes of the prurigo.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

Kowalski¹,

Kneiber²,

Valdebran³

et al. 2019

CCID

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Prurigo nodualris (PN) is a chronic condition with highly pruritic, hyperkeratotic papules or nodules arising in the setting of chronic pruritus. While PN may serve as a phenotypic presentation of several underlying conditions such as atopic dermatitis, chronic kidney disease-related pruritus, and neurological diseases, it represents a distinct clinical entity that may persist despite the removal of the underlying cause, if one is identified. Neuronal proliferation, eosinophils, mast cells, and small-fiber neuropathy play a role in the production of pruritus in PN, although the exact mechanism has not yet been established. Identifying an underlying cause, if present, is essential to prevent recurrence of PN. Due to often present comorbidities, treatment is typically multimodal with utilization of topical and systemic therapies. We performed a PubMed/MEDLINE search for PN and present a review of recent developments in the treatment of PN. Treatment typically relies on the use of topical or intralesional steroids, though more severe or recalcitrant cases often necessitate the use of phototherapy or systemic immunosuppressives. Thalidomide and lenalidomide can both be used in severe cases; however, their toxicity profile makes them less favorable. Opioid receptor antagonists and neurokinin-1 receptor antagonists represent two novel families of therapeutic agents which may effectively treat PN with a lower toxicity profile than thalidomide or lenalidomide.

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Section: Treatment Of Pnmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

Kowalski¹,

Kneiber²,

Valdebran³

et al. 2019

CCID

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“…Pemphigoid nodularis (PN) is a rare variant of BP having clinical features of prurigo nodularis with an autoantibody profile of BP (4). Hyperkeratotic, excoriated and pruritic nodules on the extremities can be the first sign of PN anticipating the blisters by weeks or months.…”

Section: Introductionmentioning

confidence: 99%

Pemphigoid nodularis - rare presentation of bullous pemphigoid: A case report and literature review

et al. 2018

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Pemphigoid nodularis (PN) is a rare clinical variant of bullous pemphigoid characterized by the presence of nodular prurigo-like lesions and pemphigoid blisters. The diagnosis is confirmed by direct immunofluorescence (DIF)/ indirect immunofluorescence (IIF) and immunoserology tests. For some patients, with long mean duration of symptoms, the correct diagnosis of PN is delayed because the disease is not recognized. We present a case and summarize the reported characteristics of PN. The search in MEDLINE database, after selection, resulted in 36 articles presenting 47 cases of PN. Between published cases a female predominance was noted (female to male ratio of 1.8:1), almost half of the reported patients were non-Caucasian, and the mean age at presentation was 66.2 years. The mean duration until the diagnosis was almost 2 years. Sixteen patients also had other autoimmune diseases. Twenty-two patients developed vesicles/bullae/urticarial plaques before or after the diagnosis. Peripheral eosinophilia and high levels of serum total IgE were reported in 10.6 and 27.2% of patients, respectively. ELISA for either BP180, BP230 or both were positive in all tested cases. DIF and IIF microscopy were positive overall in 100 and 92.3% of cases, respectively. Corticosteroids, either topical or systemic, were the most efficient therapeutic option, although many others were used. PN remains a diagnostic and therapeutic challenge in elderly patients with unexplained refractory chronic pruritus associated with papulo-nodular lesions.

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“…The etiology of PN is completely unknown, though the disease may be caused by drugs, like nifedipine, etanercept, dipeptidyl-peptidase 4 inhibitor, psoralens, and PUVA ( 20 – 24 ). Interestingly, there are a few reports on PN coexisting with rheumatoid arthritis, lichen planus, psoriasis, or diabetes—diseases that are pruritic ( 20 , 22 , 24 – 30 ). It is highly likely that chronic, severe itching in these cases led to the damage of BMZ and exposition of its antigens and subsequently to the PN development.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature

et al. 2022

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Pemphigoid nodularis is a rare form of pemphigoid that joins the clinical picture of prurigo nodularis and the immunological features of bullous pemphigoid, which is therapeutically challenging. Here, we analyze five female patients with a long-lasting course of nodular pemphigoid in terms of clinical and immunological characteristics and therapy. All the patients fulfilled clinical and immunological criteria of nodular pemphigoid. We applied numerous techniques allowing the proper diagnosis: direct and indirect immunofluorescence, salt split skin, ELISA, BIOCHIP, and fluorescence overlay antigen mapping using laser scanning confocal microscopy. Our study showed that 4 of 5 patients fulfilled the clinical and immunological criteria of nodular bullous pemphigoid. Two out of 4 patients presented exclusively nodular lesions; in the other two patients, blisters and erythematous lesions preceded prurigo-like lesions by a few years. The remaining patient had clinical and immunological criteria of nodular mucous membrane pemphigoid, presenting oral erosions, scarring conjunctivitis, and numerous disseminated nodules on the skin. All the patients were treated with multiple medicines; however, it was observed that the use of clobetasol propionate on the entire body plus antidepressants best controlled the disease. Pemphigoid nodularis mainly occurs in elderly women. In cases with coexisting psychological problems, antidepressants should be considered as an important complementary therapy to the basic one with clobetasol propionate.

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Vesiculobullous eruption in a patient receiving psoralen ultraviolet A (PUVA) treatment for prurigo nodules: a case of PUVA-aggravated pemphigoid nodularis

Cited by 11 publications

References 7 publications

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

Pemphigoid nodularis - rare presentation of bullous pemphigoid: A case report and literature review

Case Report: Pemphigoid Nodularis—Five Patients With Many Years of Follow-Up and Review of the Literature

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