Coexistent psoriasis and bullous pemphigoid responding to mycophenolate mofetil monotherapy.
Coexistent psoriasis and bullous pemphigoid responding to mycophenolate mofetil monotherapy.
复制标题
共存的银屑病和大疱性类天疱疮对吗替麦考酚酯单一疗法有反应。
DOI：
10.1111/j.1751-7125.2008.07318.x
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
V. Anyfantakis
中科院分区：
文献类型：
--
作者：
E. Rallis;V. Anyfantakis
一名 73 岁女性，有 50 年银屑病病史，因红斑基底紧张性大疱持续 4 个月，下肢和躯干局部糜烂而被转诊至我们诊所（图 1A）。口腔和眼粘膜均未受累。皮损严重瘙痒，严重影响了她的生活质量。检查时，患者出现仅限于头皮的银屑病斑块和附着的鳞屑（图 2A）。根据患者病史，偶尔使用外用药物（外用皮质类固醇、卡泊三醇和焦油洗发水）可部分控制其有限的牛皮癣。她还患有胰岛素依赖型糖尿病、哮喘性支气管炎和部分控制的高血压伴高脂血症。从她脚上的病变皮肤中取出活检标本，组织学检查显示表皮下水疱，真皮上层有炎症细胞浸润。没有与药物相关，并且通过血清的蛋白质免疫印迹证实了大疱性类天疱疮的诊断。实验室检查显示轻度血小板减少为 110,000/mm(3)，胆固醇为 279 mg/dL，甘油三酯为 210 mg/dL。患者因高血压和糖尿病而不能耐受泼尼松龙和环孢素，或因轻度血小板减少而不能耐受硫唑嘌呤；她不同意接受生物制剂。吗替麦考酚酯 (MMF) 随后被认为是一种选择。患者同意了，最初给予她 1000 mg/d。 2周后，由于新水泡的形成，剂量增加至1000mg，每天两次。在接受 MMF 2000 mg/d 治疗 8 周内，观察到明显改善，瘙痒得到缓解。大疱性类天疱疮和银屑病分别在 3 个月和 4 个月内完全缓解。治疗前和治疗期间每月进行常规实验室研究，MMF 耐受性良好，无副作用。治疗持续 6 个月，随后皮肤病没有复发（图 1B 和图 2B）。
A 73-year-old woman with a 50-year history of psoriasis was referred to our clinic with a 4-month duration of tense bullae on erythematous base and erosions localized on her lower extremities and torso (Figure 1A). Neither the oral nor the ocular mucosa had been involved. The lesions were intensively pruritic, significantly affecting the quality of her life. At the time of the examination, the patient presented with psoriatic plaques with adherent scales confined on the scalp (Figure 2A). According to the patient's history, her limited psoriasis was partially controlled with occasional topical medications (topical corticosteroids, calcipotriol, and tar shampoo). She also had insulin-dependent diabetes mellitus, asthmatic bronchitis, and partially controlled hypertension with hyperlipidemia. A biopsy specimen was taken from lesional skin on her feet, and a histological examination showed a subepidermal blister with an inflammatory cell infiltrate in the upper dermis. No drugs were incriminated, and diagnosis of bullous pemphigoid was confirmed by Western immunoblotting of serum. Laboratory investigation revealed mild thrombocytopenia of 110,000/mm(3), cholesterol 279 mg/dL, and triglycerides 210 mg/dL. The patient could not tolerate prednisolone and cyclosporine because of hypertension and diabetes, or azathioprine because of the mild thrombocytopenia; she did not consent to receiving biologics. Mycophenolate mofetil (MMF) was then considered a choice. The patient agreed, and she was initially administered 1000 mg/d. After 2 weeks, the dosage increased to 1000 mg twice a day because of the formation of new blisters. Within 8 weeks of treatment with MMF 2000 mg/d, marked improvement was observed and her pruritus resolved. Complete remission of bullous pemphigoid and psoriasis was achieved within 3 and 4 months, respectively. Routine laboratory studies were performed before treatment and every month during therapy, and MMF was tolerated without side effects. The treatment was continued for 6 months with no subsequent relapse of the dermatoses (Figure 1B and Figure 2B).