Kirtschig G, Chow E T, Venning V A, Wojnarowska F T
Department of Dermatology, University of Marburg, Germany.
Br J Dermatol. 1996 Nov;135(5):738-45.
Clinical, immunopathological and immunogenetic studies of four patients with a subepidermal bullous disease associated with psoriasis were carried out to determine the true nature of the blistering disease and to investigate further the relationship between psoriasis and acquired subepidermal bullous diseases. Autoantibodies in all four patients bound to the epidermal side of salt-split skin by indirect immunofluorescence and detected the major bullous pemphigoid (BP) antigens by immunoblotting. One had additional IgA autoantibodies binding an epidermal polypeptide of 270/280 kDa and another had circulating IgG autoantibodies which detected both BP and epidermolysis bullosa acquisita (EBA) antigens. All patients had active psoriasis at the onset of the bullous disease. Three patients were being treated with tar when blisters developed; one patient also received UVB radiation and experienced a relapse after exposure to sunlight. HLA phenotypes in three patients were determined. All the patients responded well to methotrexate. These findings demonstrate that BP is the subepidermal bullous disease most associated with psoriasis. Changes at the basement membrane zone in psoriasis may be responsible for the heterogeneous antibody response and may trigger the bullous disease, as may antipsoriatic treatment including tar and UV radiation. However, common immunogenetic mechanisms may play a crucial part in this disease association.
对4例与银屑病相关的表皮下大疱性疾病患者进行了临床、免疫病理学和免疫遗传学研究，以确定该大疱性疾病的真正性质，并进一步研究银屑病与获得性表皮下大疱性疾病之间的关系。所有4例患者的自身抗体通过间接免疫荧光法与盐裂皮肤的表皮侧结合，并通过免疫印迹法检测到主要的大疱性类天疱疮（BP）抗原。1例患者有额外的IgA自身抗体结合270/280 kDa的表皮多肽，另1例患者有循环IgG自身抗体，可检测到BP和获得性大疱性表皮松解症（EBA）抗原。所有患者在大疱性疾病发作时均有活动性银屑病。3例患者在水疱出现时正在接受焦油治疗；1例患者还接受了UVB照射，并在暴露于阳光下后复发。确定了3例患者的HLA表型。所有患者对甲氨蝶呤反应良好。这些发现表明，BP是与银屑病最相关的表皮下大疱性疾病。银屑病患者基底膜带的变化可能是导致异质性抗体反应的原因，并可能引发大疱性疾病，包括焦油和紫外线辐射在内的抗银屑病治疗也可能如此。然而，共同的免疫遗传机制可能在这种疾病关联中起关键作用。
