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Bullous Pemphigoid Arising in Psoriasis Treatment with Methotrexate -A Case Report and Literature Review-
Wen-Wei Lin, Hao-Chiung Lin, Kit-Ching Wong
Dermatol Sinica 15: 56-60, 1997

Bullous pemphigoid complicated with psoriasis was rarely reported in the literature. Many authors assumed that the coexistence of psoriasis and bullous pemphigoid was associated with some antipsoriatic treatment, especially UV light phototherapy.Herein we report a male patient with 5-year history of psoriasis treated mainly with topical steroids. Blisters developed on his bilateral lower extremities in October 1995. The skin biopsy with H&E stain and direct immunofluoresecent test showed findings consistent with bullous pemphigoid. He was given methotrexate 20 mg per week intramuscularly for two months. The blisters and erosions completely disappeared, and the original psoriatic plaques became much improved. Methotrexate was then switched to oral administration and the dosage was tapered gradually to 7.5mg/wk maintence dose. In the following six months, there were only a few psoriatic lesions reappeared, but no recurrenc of blisters.

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