Bullous pemphigoid in a patient with erythrodermic psoriasis provoked by topical treatment with altacet

Introduction. Psoriasis is a chronic, inflammatory and proliferative skin disease with a complex pathogenesis. Associations between psoriasis and various systemic and skin disorders have been reported. In the literature, there are also a few reports of coexistence of bullous pemphigoid with psoriasis.

Objective. The aim of this paper was to present a patient with psoriasis, in whom, after topical application of altacet (aluminum acetotartrate) bullous pemphigoid developed.

Case report. We present a case of 63-year-old patient with 4-month history of psoriasis, in whom after chronic topical treatment with high-potency corticosteroids, exacerbation of skin lesions with tendency to erythroderma occured. During the hospitalization generalized inflammation of the skin and appearance of numerous pustules were observed. Laboratory tests revealed increase in concentrations of markers of inflammation. Oral antibiotic and neutral moisturizing topical treatment were administered. In the following days swelling of the dorsa of the hands and feet were observed on which compresses with altacet were applied. The next day tense blisters were observed, initially on the skin of the hands and feet, then on the trunk and upper and lower extremities. Immunological test of serum confirmed the diagnosis of bullous pemphigoid. After systemic (antibiotic and acitretin) and topical treatment receding of skin lesions was observed.

Conclusions. In the presented case chronic topical glicocorticosteroid therapy caused erythrodermic form of psoriasis. Due to the swelling of hands and feet compressess with altacet were applied which provoked bullous pemphigoid, confirmed immunologically. Pathogenetic link between this two diseases remains unclear. Coexistence of psoriasis and pemphigoid may cause the therapeutic difficulties and requires careful therapeutic approach.