The coincidence of psoriasis vulgaris and pemphigus foliaceous in geriatric after COVID-19 vaccination

Abstract

Background: Psoriasis is a chronic autoimmune disease characterized by well-demarcated, erythematous, scaly plaques, such as mica. Psoriasis occurs as a damaging result of Th17, TNF-α, and IFN-γ cells. The coincidence of psoriasis with pemphigus foliaceous is rare. Several studies have shown that Th17, TNF-α, and IFN-γ cells induced by COVID-19 vaccination can play a role in this mechanism although it remains unclear. Case series: A 60-year-old woman without comorbidities with a 6-year history of controlled psoriasis, since 2016, with the administration of methotrexate and phototherapy. The diagnosis of psoriasis is clinically based on the form of erythematous, scaly plaques scattered throughout the body. The patient got the COVID-19 vaccination twice during the pandemic, followed by the exacerbation of psoriasis and coincidence with pemphigus foliaceus. The biopsy showed epidermal acantholysis with perivascular infiltration of PMN inflammatory cells and lymphocytes. The patient did not improve with the administration of methotrexate and phototherapy but showed improvement with methylprednisolone injections with tapering. Psoriasis relapsed again, but the patient improved after being given 4 times injections of secukinumab. Conclusion: COVID-19 vaccination is necessary during a pandemic, but can lead to post-vaccination autoimmune exacerbations, such as the coincidence of psoriasis and pemphigus foliaceus. More research is needed to understand the potential of COVID-19 vaccination which is the first mRNA vaccine in humans.