{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:39:12Z","timestamp":1772433552126,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2004,12,7]],"date-time":"2004-12-07T00:00:00Z","timestamp":1102377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2006,9]]},"abstract":"<jats:p>A 65\u2010year\u2010old woman had a history of deep vein thrombosis and depression. Psoriasis was diagnosed in 1986 and various topical and systemic therapies, singly or in combination, were prescribed: tar, topical corticosteroids, cyclosporine, etretinate, and methotrexate. Two courses of oral and one course of bath psoralen plus UVA (PUVA) therapy (cumulative dose, 467\u00a0J\/cm<jats:sup>2<\/jats:sup>) and UVB (2.96\u00a0J\/cm<jats:sup>2<\/jats:sup>) had been given.<\/jats:p><jats:p>In January 1999, she developed a flare of generalized psoriasis. In May 1999, therapy with PUVA (8\u2010methoxypsoralen) plus topical acetonide triamcinolone 0.1% was initiated. At the time, she was taking acenocoumarol, lorazepam, and hydroxyzine chlorhydrate. In August 1999, at session 30, when the dose of UVA was 9\u00a0J\/cm<jats:sup>2<\/jats:sup>, and the total dose was 205\u00a0J\/cm<jats:sup>2<\/jats:sup>, a bulla appeared on the dorsum of the toe and was controlled with topical antibiotics. Five further sessions of PUVA were given and a generalized itching bullous eruption appeared all over the body. PUVA was stopped and the patient was hospitalized.<\/jats:p><jats:p>On physical examination, extensive psoriatic plaques plus vesicles and bullae on the normal skin and on psoriatic lesions were observed all over the body (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f1\">Fig.\u00a01<\/jats:ext-link>).<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Clinical aspect of the bullae on the psoriatic plaques<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD2517:IJD_2517_f1\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p>Histopathologic study of a lesion showed a subepidermal vesicle containing fibrin, neutrophils, and a few eosinophils. No sunburn cells were observed (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f2\">Fig.\u00a02<\/jats:ext-link>).<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Histopathologic aspect of a lesion, showing a subepidermal vesicle containing fibrin, neutrophils, and a few eosinophils (hematoxylin and eosin, \u00d7200)<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD2517:IJD_2517_f2\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p>The direct immunofluorescence (DIF) test of perilesional uninvolved skin revealed immunoglobulin G (IgG) (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f3\">Fig.\u00a03<\/jats:ext-link>) and C3 at the dermal\u2013epidermal junction. The DIF study using the patient's skin, previously treated with 1\u00a0<jats:sc>m<\/jats:sc> NaCl, localized the IgG at both the epidermal and dermal sides of the basement membrane zone (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f4\">Fig.\u00a04<\/jats:ext-link>).<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Direct immunofluorescence test of uninvolved skin showing linear deposits of immunoglobulin G (IgG) at the dermal\u2013epidermal junction (\u00d7400)<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD2517:IJD_2517_f3\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Direct immunofluorescence test showing immunoglobulin G (IgG) at the epidermal and dermal sides of the 1\u00a0<jats:sc>m<\/jats:sc> NaCl\u2010induced vesicle (\u00d7400)<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD2517:IJD_2517_f4\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p>Bullous pemphigoid (BP) was diagnosed and therapy with prednisone (60\u00a0mg\/day) was started. The disease was well controlled in 3\u00a0weeks. The dose of prednisone was tapered and stopped 20\u00a0months later, without any recurrence.<\/jats:p><jats:p>Study of the antibodies by the indirect immunofluorescence (IIF) test, using monkey esophagus and guinea pig as substrate, was positive at a titer of 1\/160 in September 1999. The titer decreased to 1\/10 in January 2000, and was negative in July 2000.<\/jats:p><jats:p>An enzyme\u2010linked immunosorbent assay (ELISA) test, performed using the commercial kit MBL, which identifies antibodies directed against epitopes of the extracellular fragment NC16 of antigen 2 of BP, was positive at 15\u00a0U\/mL (normal value, &lt;\u00a09\u00a0U\/mL) in September 1999, and negative in July 2000 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#t1\">Table\u00a01<\/jats:ext-link>).<\/jats:p><jats:p><jats:table-wrap>\n\n<jats:caption><jats:title>Clinical activity, indirect immunofluorescence (IIF) and enzyme\u2010linked immunosorbent assay (ELISA) in the course of the disease<\/jats:title><\/jats:caption>\n\n<jats:table frame=\"hsides\">\n<jats:col\/>\n<jats:col\/>\n<jats:col\/>\n<jats:col\/>\n<jats:thead>\n<jats:tr>\n<jats:th> <jats:bold>Date<\/jats:bold> <\/jats:th>\n<jats:th> <jats:bold>Clinical activity<\/jats:bold> <\/jats:th>\n<jats:th> <jats:bold>IIF test<\/jats:bold> <\/jats:th>\n<jats:th> <jats:bold>ELISA test<\/jats:bold> <\/jats:th>\n<\/jats:tr>\n<\/jats:thead>\n<jats:tbody>\n<jats:tr>\n<jats:td>9\/1999<\/jats:td>\n<jats:td>+++<\/jats:td>\n<jats:td>1\/160<\/jats:td>\n<jats:td>15<\/jats:td>\n<\/jats:tr>\n<jats:tr>\n<jats:td>1\/2000<\/jats:td>\n<jats:td>(\u2013)<\/jats:td>\n<jats:td>1\/10<\/jats:td>\n<jats:td>not tested<\/jats:td>\n<\/jats:tr>\n<jats:tr>\n<jats:td>7\/2000<\/jats:td>\n<jats:td>(\u2013)<\/jats:td>\n<jats:td>(\u2013)<\/jats:td>\n<jats:td>(\u2013)<\/jats:td>\n<\/jats:tr>\n<\/jats:tbody>\n<\/jats:table>\n\n<\/jats:table-wrap><\/jats:p>","DOI":"10.1111\/j.1365-4632.2004.02517.x","type":"journal-article","created":{"date-parts":[[2006,6,6]],"date-time":"2006-06-06T12:12:18Z","timestamp":1149595938000},"page":"1089-1092","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Bullous pemphigoid in a patient with psoriasis during the course of PUVA therapy: study by ELISA test"],"prefix":"10.1111","volume":"45","author":[{"given":"Maria A.","family":"Barnadas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montserrat","family":"Gilaberte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ram\u00f3n","family":"Pujol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Agust\u00ed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Gelp\u00ed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augost\u00edn","family":"Alomar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,7,19]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/1523-1747.ep12338088"},{"key":"e_1_2_2_3_2","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1001\/archderm.1978.01640230017005","article-title":"Coexistent psoriasis and bullous pemphigoid. 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