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PUVA-induced lichen planus pemphigoides.

N Kuramoto¹, S Kishimoto, R Shibagaki

¹Department of Dermatology, Kyoto Prefectual University of Medicine, 465 Hirokoji, Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan. kuramo@derm.kpu-m.ac.jp

The British Journal of Dermatology

|March 29, 2000

Summary

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Psoralen ultraviolet A (PUVA) therapy for parapsoriasis may induce lichen planus pemphigoides (LPP), a rare blistering disease. Early steroid treatment effectively resolved LPP lesions in a case study.

Area of Science:

Dermatology
Immunodermatology

Background:

Parapsoriasis en plaque (large plaque type) is a chronic skin condition.
Topical psoralen ultraviolet A (PUVA) therapy is a common treatment for parapsoriasis.

Observation:

A 72-year-old woman developed pruritic red papules after PUVA therapy for parapsoriasis.
These lesions evolved into violaceous plaques with histological features of lichen planus.
Tense bullae subsequently formed on the plaques and surrounding skin.

Findings:

Immunofluorescence revealed subepidermal bullae with linear IgG and C3 deposits along the basement membrane zone (BMZ).
Immunodeposits of type IV collagen were found along the floor of the bullae.
The patient was diagnosed with lichen planus pemphigoides (LPP).

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Implications:

This case suggests PUVA therapy, in conjunction with chronic inflammation, may trigger LPP by exposing BMZ components.
Systemic and topical steroids led to rapid resolution of LPP lesions.
Understanding the pathogenesis of PUVA-induced LPP is crucial for patient management.