Psoriasis and Bullous Pemphigoid Developing Simultaneously During Systemic Administration with Bisoprolol and Losartan

Abstract

Psoriasis and bullous pemphigoid are both chronic inflammatory skin disorders, involving abnormal immune responses. Their coexistence is often observed in the literature in the context of secondary development following an initial inflammatory process. In the majority of cases, the development of psoriasis seems to occur before the onset of bullous pemphigoid. While psoriasis is associated with autoimmune bullous diseases, it’s important to note that not every individual with psoriasis will develop bullous pemphigoid. Therefore the pathogenetic mechanism behind this association remains rather a mystery. Several case reports/studies have been published describing the subsequent development of either psoriasis or bullous pemphigoid following initial monotherapy with beta blockers, sartans, or other drug class medications (which will not be mentioned in our case report as they are not relevant to the presented data). We believe that our case is the first documented example of polymedicamentous development of 2 skin diseases within the intake of 2 antihypertensive drugs heterogeneous in class and action. We present a 78-year-old female with plaque psoriasis followed shortly thereafter by bullous pemphigoid after 10-year period of antihypertensive therapy with bisoprolol and losartan. We believe that the cumulative effect of both medications may have contributed to the coexistence of these skin disorders. Following the discontinuation of the initial antihypertensive therapy with bisoprolol and losartan and substituting it verapamil and moxonidine, along with the initiation of methotrexate and folic acid, the patient showed significant improvement. Key words: psoriasis; bullous pemphigoid; drug-induced; bisoprolol; losartan