Xie Ying-Han, Wang Si-Hang, Li Si-Zhe, Zuo Ya-Gang
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Front Immunol. 2022 Mar 4;13:839094. doi: 10.3389/fimmu.2022.839094. eCollection 2022.
A close association between psoriasis and anti-p200 pemphigoid has been demonstrated by numerous studies. However, the clinical characteristics of patients suffering from these two entities have not yet been well-elucidated.
This study aimed to review the case reports and case series, summarizing clinical features and therapeutic strategies in patients suffering from anti-p200 pemphigoid and psoriasis.
A systematic review was conducted by searching PubMed, EMBASE, and Web of Science databases for studies published in English involving patients with psoriasis and anti-p200 pemphigoid on 6 September 2021. All case reports and case series reporting patients diagnosed with anti-p200 pemphigoid and psoriasis were included in this systematic review.
A total of 21 eligible studies comprising 26 anti-p200 pemphigoid patients with preceding psoriasis were included in the qualitative synthesis. The average age at blisters eruption was 62.5 years, and the mean duration between the two entities was 15.6 years. Twenty-four percent of patients developed bullous lesions during UV therapy. Clinical manifestation of bullae and/or vesicles was recorded in all patients, and the trunk (94.7%) was most frequently involved, with only 15.8% reporting mucosal involvement. Epitope spreading was detected by immunoblotting in 33.3% of patients. All the patients reached completed remission during the course of disease, with 36.8% experiencing at least one relapse. Monotherapy of prednisolone was the leading therapeutic approach (n=6, 31.6%) required for disease control, but 5 (83.3%) of them suffered from blister recurrence after tapering or ceasing corticosteroid.
Most of the clinical aspects of patients with anti-p200 pemphigoid and psoriasis were similar to what was demonstrated in previous articles on anti-p200 pemphigoid. Nevertheless, compared with other anti-p200 pemphigoid cases without psoriasis, a clinical manifestation pattern with more frequent involvement of the trunk and less mucosal involvement was illustrated in those with psoriasis. Generally, monotherapy is sufficient for a complete remission for such patients. However, one or more relapses have been recorded in a considerable portion of patients, especially those prescribed with prednisolone. It reminded us to be more cautious during a tapering of medication.
众多研究已证实银屑病与抗p200类天疱疮之间存在密切关联。然而，这两种疾病患者的临床特征尚未得到充分阐明。
本研究旨在回顾病例报告和病例系列，总结抗p200类天疱疮合并银屑病患者的临床特征及治疗策略。
于2021年9月6日通过检索PubMed、EMBASE和Web of Science数据库，对以英文发表的涉及银屑病和抗p200类天疱疮患者的研究进行系统综述。所有报告诊断为抗p200类天疱疮合并银屑病患者的病例报告和病例系列均纳入本系统综述。
定性分析共纳入21项符合条件的研究，包括26例先前患有银屑病的抗p200类天疱疮患者。水疱出现时的平均年龄为62.5岁，两种疾病之间的平均间隔时间为15.6年。24%的患者在紫外线治疗期间出现大疱性皮损。所有患者均记录有大疱和/或水疱的临床表现，其中躯干受累最为常见（94.7%），仅有15.8%的患者报告有黏膜受累。33.3%的患者通过免疫印迹检测到抗原表位扩展。所有患者在病程中均达到完全缓解，36.8%的患者至少经历一次复发。泼尼松龙单药治疗是控制疾病的主要治疗方法（n = 6，31.6%），但其中5例（83.3%）在糖皮质激素减量或停药后出现水疱复发。
抗p200类天疱疮合并银屑病患者的大多数临床情况与先前关于抗p200类天疱疮的文章中所描述的相似。然而，与其他无银屑病的抗p200类天疱疮病例相比，合并银屑病的患者表现出一种更频繁累及躯干且较少累及黏膜的临床表现模式。一般来说，单药治疗足以使此类患者完全缓解。然而，相当一部分患者记录有一次或多次复发，尤其是那些使用泼尼松龙治疗的患者。这提醒我们在药物减量时要更加谨慎。
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