Interaction of Psoriasis and Bullous Diseases

Abstract

Patients with psoriasis are frequently complicated with autoimmune bullous diseases, especially, pemphigoid diseases. It has been known that one-third cases of anti-laminin gamma1 pemphigoid, formerly anti-p200 pemphigoid, are associated with psoriasis whereas bullous pemphigoid is the most frequently associated bullous disease in psoriasis cases regardless of the lack of detectable levels of the accompanying anti-laminin gamma1 autoantibodies. Despite several suggestions, however, the definitive reason of the striking association of psoriasis and these autoimmune bullous diseases remains elusive. In this review, we look over the epidemiological evidence of the association of psoriasis and autoimmune bullous diseases and the information of genetic susceptibilities of each disease, and discuss the possible mechanisms of their complication with reference to the recent understandings of each pathogenesis.

Keywords: MMP; Th17; Th2; autoimmunity; laminin; pemphigoid; psoriasis; senescence.

Figure 1

Publication of the report of cases with association of psoriasis and bullous diseases until the end of 2017. All the publications were searched in PubMed database, and case reports and case series were selected manually with exclusion of redundancy. Cases with coexistence of two or more autoimmune blistering diseases were counted in each category: (psoriasis[tiab] AND pemphigoid[tiab]) for pemphigoid diseases; (psoriasis[tiab] AND pemphigus[tiab] NOT pemphigoid[tiab]) for pemphigus; psoriasis[tiab] AND (epidermolysis bullosa acquisita[tiab]) for epidermolysis bullosa acquisita; psoriasis AND (epidermolysis bullosa hereditaria OR epidermolysis bullosa simplex OR junctional epidermolysis bullosa OR dystrophic epidermolysis bullosa OR kindler's syndrome OR kindler syndrome) for epidermolysis bullosa hereditaria; psoriasis[tiab] AND (hailey-hailey OR familial pemphigus OR familial benign chronic pemphigus) for Hailey-Hailey disease. References are as follows. Pemphigus (24): 1990 or earlier (5) (–5); 1991–2000 (5) (–10); 2001–2010 (6) (–16); 2011 or later (8) (–25). Pemphigoid (84): 1980 or earlier (7) (–32); 1981–1990 (16) (, –47); 1991–2000 (10) (–57); 2001–2010 (21) (–78); 2011 or later (30) (–109). Epidermolysis bullosa acquisita (7) (, –115). Epidermolysis bullosa hereditaria (1) (116). Hailey-Hailey disease (7) (–123).

Figure 2

Component of pemphigoid diseases associated with psoriasis (124).

Figure 3

A mechanistic model to produce autoantibodies in psoriasis. Can switch from the Th1/Th17-dominant to Th2/Th17-dominant state be involved?.