Timofte Maria-Alexandra, Căruntu Constantin, Bălăceanu-Gurău Beatrice, Mărgăritescu Irina, Giurcăneanu Călin, Mihai Mara Mădălina
Department of Oncologic Dermatology, "Elias" Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Physiology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Clin Pract. 2025 May 8;15(5):91. doi: 10.3390/clinpract15050091.
Bullous pemphigoid (BP) is a rare autoimmune disease, primarily affecting elderly individuals, that significantly impacts the patient's quality of life. In contrast, psoriasis vulgaris (PV) is a common, chronic, immune-mediated skin condition recognized as a systemic T-cell-mediated disorder. We aim to present the case of a patient suffering from a dermatologic association of BP and PV, which unveiled hepatitis C viral infection as a potential trigger and led to complex therapeutic challenges. A literature review is also included, exploring previous cases of overlapping BP and PV, along with a discussion of the unique pathogenic mechanisms and an analysis of the available therapeutic options. The patient, a 53-year-old male with a seven-year history of PV, presented with tense bullae overlying the psoriatic papules and plaques, with a generalized distribution. The presence of hepatitis C infection was considered a potential trigger for the concurrent presentation of BP and PV. Recent GWASs have demonstrated a potential causal relationship between PV and the subsequent development of BP, suggesting shared genetic susceptibility and immune pathways. However, the exact mechanisms driving this transition remain incompletely understood. Our case is particularly relevant as it exemplifies how environmental triggers-such as chronic hepatitis C infection-together with chronic cutaneous inflammation may act as cofactors in this process, possibly through the 'epitope spreading' phenomenon. This case underlines the importance of identifying triggering factors in patients with overlapping autoimmune diseases and reinforces the need for future research to further elucidate the pathogenic link between genotype and phenotype, in order to improve personalized therapeutic strategies.
大疱性类天疱疮（BP）是一种罕见的自身免疫性疾病，主要影响老年人，对患者的生活质量有显著影响。相比之下，寻常型银屑病（PV）是一种常见的慢性免疫介导性皮肤病，被认为是一种系统性T细胞介导的疾病。我们旨在介绍一例患有BP和PV皮肤关联的患者病例，该病例揭示丙型肝炎病毒感染可能是触发因素，并导致了复杂的治疗挑战。本文还包括文献综述，探讨既往BP和PV重叠的病例，以及对独特致病机制的讨论和对现有治疗选择的分析。该患者为一名53岁男性，有7年PV病史，表现为银屑病丘疹和斑块上出现紧张性大疱，呈泛发性分布。丙型肝炎感染的存在被认为是BP和PV同时出现的潜在触发因素。最近的全基因组关联研究（GWAS）表明PV与随后发生BP之间存在潜在因果关系，提示存在共同的遗传易感性和免疫途径。然而，驱动这种转变的确切机制仍未完全明了。我们的病例特别具有相关性，因为它例证了诸如慢性丙型肝炎感染等环境触发因素如何与慢性皮肤炎症一起，可能通过“表位扩展”现象在此过程中作为辅助因素起作用。该病例强调了识别自身免疫性疾病重叠患者触发因素的重要性，并强化了未来研究进一步阐明基因型与表型之间致病联系以改善个性化治疗策略的必要性。
