Skip to main content

Advertisement

SpringerLink
Log in

The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis

  • Original Article
  • Published:
Immunologic Research Aims and scope Submit manuscript

Abstract

There is little consensus regarding the association between pemphigus and psoriasis. The aim of the current study is to synthesize existing data on the prevalence of psoriasis in patients with pemphigus and on the association between the two conditions. We performed a systematic review and meta-analysis of observational studies in Medline, Embase, and Web of Science (1900–2018). Reference lists of included studies were also searched for eligible studies. Quality of evidence was assessed using Newcastle-Ottawa scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled prevalence rates and odds ratios (ORs) with 95% confidence intervals (CI). Subgroup and sensitivity analyses were also conducted. Twelve eligible studies comprising 12,238 patients with pemphigus were included in the quantitative synthesis. The overall random-effects pooled prevalence of psoriasis among patients with pemphigus was 2.4% (95% CI, 1.0–4.4) across all studies. The overall pooled multivariate OR for psoriasis in patients with pemphigus was significantly increased and estimated at 3.5 (95% CI, 1.6–7.6). In conclusion, a significant association was found between pemphigus and psoriasis. Physicians managing patients with pemphigus may be aware of this comorbidity. Further studies are warranted to establish the precise mechanisms underlying this relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hammers CM, Stanley JR. Mechanisms of disease: pemphigus and bullous pemphigoid. Annu Rev Pathol Mech Dis. 2016;11:175–97.

    Article  CAS  Google Scholar 

  2. Stanley JR, Amagai M. Mechanisms of disease pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med. 2006;355:1800–10.

    Article  CAS  PubMed  Google Scholar 

  3. Schön MP, Boehncke W-H. Psoriasis. N Engl J Med. 2005;352:1899–912.

    Article  PubMed  Google Scholar 

  4. Nickoloff BJ, Schröder JM, von den Driesch P, et al. Is psoriasis a T-cell disease? Exp Dermatol. 2000;9:359–75.

    Article  CAS  PubMed  Google Scholar 

  5. Kridin K, Bergman R. Association between bullous pemphigoid and psoriasis: a case-control study. J Am Acad Dermatol. 2017;77:370–2.

    Article  PubMed  Google Scholar 

  6. Grattan CE. Evidence of an association between bullous pemphigoid and psoriasis. Br J Dermatol. 1985;113:281–3.

    Article  CAS  PubMed  Google Scholar 

  7. Chen YJ, Wu CY, Lin MW, Chen TJ, Liao KK, Chen YC, et al. Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study. Br J Dermatol. 2011;165:593–9.

    Article  CAS  PubMed  Google Scholar 

  8. Tsai T-F, Wang T-S, Hung S-T, Tsai PIC, Schenkel B, Zhang M, et al. Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. J Dermatol Sci. 2011;63:40–6.

    Article  PubMed  Google Scholar 

  9. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  10. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67:974–8.

    Article  PubMed  Google Scholar 

  11. Ramos W, Chacon GR, Galarza C, Gutierrez EL, Smith ME, Ortega-Loayza AG. Endemic pemphigus in the peruvian Amazon: epidemiology and risk factors for the development of complications during treatment. An Bras Dermatol. 2012;87:838–45.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kridin K, Zelber-Sagi S, Comaneshter D, Cohen AD. Association between pemphigus and psoriasis: a population-based large-scale study. J Am Acad Dermatol. 2017;77:1174–5.

    Article  PubMed  Google Scholar 

  13. Chiu Y-W, Chen Y-D, Hua T-C, Wu CH, Liu HN, Chang YT. Comorbid autoimmune diseases in patients with pemphigus: a nationwide case-control study in Taiwan. Eur J Dermatol. 2017;27:375–81.

    PubMed  Google Scholar 

  14. Uzun S, Durdu M, Akman A, Gunasti S, Uslular C, Memisoglu HR, et al. Pemphigus in the Mediterranean region of Turkey: a study of 148 cases. Int J Dermatol. 2006;45:523–8.

    Article  PubMed  Google Scholar 

  15. Shah A, Seiffert-Sinha K, Sirois D, Werth VP, Rengarajan B, Zrnchik W, et al. Development of a disease registry for autoimmune bullous diseases: initial analysis of the pemphigus vulgaris subset. Acta Derm Venereol. 2015;95:86–90.

    Article  PubMed  Google Scholar 

  16. Hsu DY, Brieva J, Sinha AA, Langan SM, Silverberg JI. Comorbidities and inpatient mortality for pemphigus in the U.S.a. Br J Dermatol. 2016;174:1290–8.

    Article  CAS  PubMed  Google Scholar 

  17. Heelan K, Mahar AL, Walsh S, Shear NH. Pemphigus and associated comorbidities: a cross-sectional study. Clin Exp Dermatol. 2015;40:593–9.

    Article  CAS  PubMed  Google Scholar 

  18. Gupta VK, Kelbel TE, Nguyen D, Melonakos KC, Murrell DF, Xie Y, et al. A globally available internet-based patient survey of pemphigus vulgaris: epidemiology and disease characteristics. Dermatol Clin. 2011;29:393–404.

    Article  CAS  PubMed  Google Scholar 

  19. Kridin K, Zelber-Sagi S, Khamaisi M, Cohen AD, Bergman R. Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region. J Am Acad Dermatol. 2016;75:925–30.

    Article  PubMed  Google Scholar 

  20. Baum S, Astman N, Berco E, et al. Epidemiological data of 290 pemphigus vulgaris patients: a 29-year retrospective study. doi.org 2016; 26:382–7.

  21. Micali G, Musumeci ML, Nasca MR. Epidemiologic analysis and clinical course of 84 consecutive cases of pemphigus in eastern Sicily. Int J Dermatol. 1998;37:197–200.

    Article  CAS  PubMed  Google Scholar 

  22. Zhu X, Pan J, Yu Z, Wang Y, Cai L, Zheng S. Epidemiology of pemphigus vulgaris in the Northeast China: a 10-year retrospective study. J Dermatol. 2014;41:70–5.

    Article  PubMed  Google Scholar 

  23. Kridin K, Zelber-Sagi S, Khamaisi M, Cohen AD, Bergman R. Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region. J Am Acad Dermatol. 2016;75:925–30. https://doi.org/10.1016/j.jaad.2016.06.055.

    Article  PubMed  Google Scholar 

  24. Lee CW, Ro YS, Kim JH. Concurrent development of pemphigus foliaceus and psoriasis. Int J Dermatol. 1985;24:316–7.

    Article  CAS  PubMed  Google Scholar 

  25. Aghassi D, Dover JS. Pemphigus foliaceus induced by psoralen-UV-A. Arch Dermatol. 1998;134:1300–1.

    Article  CAS  PubMed  Google Scholar 

  26. Lee CW, Ro YS. Pemphigus developed on preexisting dermatoses. J Dermatol. 1994;21:213–5.

    Article  CAS  PubMed  Google Scholar 

  27. Tomasini D, Cerri A, Cozzani E, Berti E. Development of pemphigus foliaceus in a patient with psoriasis: a simple coincidence? Eur J Dermatol. 8:56–9.

  28. Yokoo M, Oka D, Ueki H. Coexistence of psoriasis vulgaris and pemphigus foliaceus. Dermatologica. 1989;179:222–3.

    Article  CAS  PubMed  Google Scholar 

  29. Perez GL, Agger WA, Abellera RM, Dahlberg P. Pemphigus foliaceus coexisting with IgA nephropathy in a patient with psoriasis vulgaris. Int J Dermatol. 1995;34:794–6.

    Article  CAS  PubMed  Google Scholar 

  30. Giomi B, Cardinali C, Pestelli E, Caproni M, Fabbri P. Pemphigus foliaceus developing on pre-existing psoriasis: a supposed pathogenetic linkage. Acta Derm Venereol. 2004;84:82–3.

    Article  PubMed  Google Scholar 

  31. Kurtzman DJB, Christopher M, Lian F, Sligh JE. A blistering response: concurrent psoriasis and pemphigus foliaceus. Am J Med. 2015;128:24–6.

    Article  PubMed  Google Scholar 

  32. Kwon HH, Kwon IH, Chung JH, Youn JI. Pemphigus Foliaceus associated with psoriasis during the course of narrow-band UVB therapy: a simple coincidence? Ann Dermatol. 2011;23:S281–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Panzarella K, Camisa C. Coexistence of superficial pemphigus and psoriasis. Cutis. 1996;57:414–8.

    CAS  PubMed  Google Scholar 

  34. Caldarola G, Carbone A, De Simone C, Pellicano R. Development of pemphigus vulgaris in a patient with psoriasis treated with cyclosporine. J Am Acad Dermatol. 2010;63:356–7.

    Article  PubMed  Google Scholar 

  35. Fye KH, Tanenbaum L. Penicillamine-induced pemphigus vulgaris in psoriatic arthritis. J Rheumatol; 9:331–2.

  36. Fryer EJ, Lebwohl M. Pemphigus vulgaris after initiation of psoralen and UVA therapy for psoriasis. J Am Acad Dermatol. 1994;30:651–3.

    Article  CAS  PubMed  Google Scholar 

  37. Reis VM, Toledo RP, Lopez A, et al. UVB-induced acantholysis in endemic pemphigus foliaceus (Fogo selvagem) and pemphigus vulgaris. J Am Acad Dermatol. 2000;42:571–6.

    Article  CAS  PubMed  Google Scholar 

  38. Grunwald MH, David M, Feuerman EJ. Coexistence of psoriasis vulgaris and bullous diseases. J Am Acad Dermatol. 1985;13:224–8.

    Article  CAS  PubMed  Google Scholar 

  39. Van Hoang M, Chi Minh H, Van Ha P, et al. Case report: coexistence between immunoglobulin a pemphigus and psoriasis. J Am Acad Dermatol. 2009;60:AB105.

    Google Scholar 

  40. Sanchez-Palacios C, Chan LS. Development of pemphigus herpetiformis in a patient with psoriasis receiving UV-light treatment. J Cutan Pathol. 2004;31:346–9.

    Article  PubMed  Google Scholar 

  41. Morita E, Amagai M, Tanaka T, Horiuchi K, Yamamoto S. A case of herpetiform pemphigus coexisting with psoriasis vulgaris. Br J Dermatol. 1999;141:754–5.

    Article  CAS  PubMed  Google Scholar 

  42. Ohata C, Ishii N, Koga H, Fukuda S, Tateishi C, Tsuruta D, et al. Coexistence of autoimmune bullous diseases (AIBDs) and psoriasis: a series of 145 cases. J Am Acad Dermatol. 2015;73:50–5.

    Article  PubMed  Google Scholar 

  43. WHO WHO. Global Report on Psoriasis. World Heal Organ are available WHO website or can be Purch from WHO Press World Heal Organ 2016; :48.

  44. Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatology Venereol. 2017;31:205–12.

    Article  CAS  Google Scholar 

  45. Chan LS, Vanderlugt CJ, Hashimoto T, Nishikawa T, Zone JJ, Black MM, et al. Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol. 1998;110:103–9.

    Article  CAS  PubMed  Google Scholar 

  46. Cardoso CB, Uthida-Tanaka AM, Magalhães RF, et al. Association between psoriasis vulgaris and MHC-DRB, -DQB genes as a contribution to disease diagnosis. Eur J Dermatol. 15:159–63.

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Rambam Health Care Campus, POB 9602, 31096, Haifa, Israel

    Khalaf Kridin

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Mouhammad Kridin

  3. Clalit Health Services, Yavne, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Guy Shalom

  4. Department of Quality Measurements and Research, Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel

    Arnon D. Cohen

  5. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Arnon D. Cohen

Authors
  1. Khalaf Kridin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mouhammad Kridin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guy Shalom
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnon D. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalaf Kridin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Electronic supplementary material

Supplementary figure 1

Funnel plot for all the included studies reporting the prevalence of psoriasis in patients with pemphigus. (PPTX 49 kb)

Supplementary figure 2

Funnel plot for all the included studies reporting the OR for psoriasis in patients with pemphigus. (PPTX 49 kb)

ESM 3

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kridin, K., Kridin, M., Shalom, G. et al. The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis. Immunol Res 67, 134–141 (2019). https://doi.org/10.1007/s12026-018-9031-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12026-018-9031-6

Keywords

Search

Navigation