Addition of Pentoxifylline Could Reduce the Side Effects of Fumaric Acid Esters in the Treatment of Psoriasis

Abstract

Sir, then gradually decreased to normal levels as the disease activity decreased. We report on a possible association between epidermolysis This appears to be the ® rst reported case of EBA in which bullosa acquisita (EBA) and elevated levels of circulating IgE. IgE has been evaluated. Although the potential pathophysioA 23-year-old man with a 3-month history of intensely itchy logical relevance of our ® ndings is not clear as yet, we suggest blisters ful® lled the diagnostic criteria for EBA (subepidermal that it may be useful to evaluate total immunoglobulin levels blisters, linear IgG deposits in basement membrane zone, in new patients with EBA and possibly also in other blistering circulating IgG antibodies to dermal part of the basement diseases (3, 4). membranezone in split skin test, circulatingantibodies reacting with a 290 kD component in dermal extracts by immunoblotting) (1, 2). The patient was successfully treated with a REFERENCES combination of betamethasone and dapsone. After 10 months 1. Woodley DT, Briggaman RA, O’Keefe EJ, Inman AO, Queen LL, of treatment, direct immuno uorescence had become negative, Gammon WR. Identi® cation of the skin basement-membrane and circulating antibodies to basement membrane zone comautoantigen in epidermolysis bullosa acquisita. N Engl J Med 1984; ponents could no longer be detected. Treatment was discon310: 1007± 1013. tinued after 15 months, and the patient has been in remission 2. Shimizu H, McDonald JN, Gunner DB, Black MM, Bhogal B, Leigh IM, et al. Epidermolysis bullosa acquisita antigen and the during the 2 months that have elapsed since the treatment carboxy terminus of type VII collagen have a common immunowas stopped. localization to anchoring ® brils and lamina densa of basement Interestingly, the patient had elevated serum levels of IgE membrane. Br J Dermatol 1990; 122: 577± 585. (3,480 IU/ml vs. normally <250IU/ml) at the ® rst visit. 3. Maekawa N, Hosokawa H, Soh H, Kasahara M, Izumi H, Radio-allergosorbent tests showed polyclonal IgE against a Yodoi J, et al. Serum levels of soluble CD23 in patients with wide variety of common environmental allergens such as dustbullous pemphigoid. J Dermatol 1995; 22: 310± 315. and house mites, and Candida albicans. The serum IgE levels 4. Soh H, Hosokawa H, Asada Y. IgE and its related phenomena in bullous pemphigoid. Br J Dermatol 1993; 128: 371± 377. remained high as long as the patient had skin symptoms, but