Glucocorticoids Combined with Methotrexate in the Treatment of Psoriasis Merged with Bullous Pemphigoid: A Case Report and Literature Review

Glucocorticoids Combined with Methotrexate in the Treatment of Psoriasis Merged with Bullous Pemphigoid: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Glucocorticoids Combined with Methotrexate in the Treatment of Psoriasis Merged with Bullous Pemphigoid: A Case Report and Literature Review Weimin Ma, Cheng Li, Haijun Miao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7415434/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This case report describes the diagnosis and treatment of a 64-year-old male patient with psoriasis complicated by Bullous Pemphigoid (BP). The patient developed new-onset tension blisters on chronic psoriatic plaques, with coexistence confirmed by histopathology and direct immunofluorescence. A combined regimen of methylprednisolone and methotrexate resulted in the complete extinction of skin lesions after three months. Literature integration revealed: 1) Th17/Th2 immune imbalance is a pivotal mechanism, where IL-17A may degrade BP180 antigen via MMP-9 upregulation; 2) Early corticosteroid-immunosuppressant therapy effectively controls disease activity, yet 30–40% of patients relapse during corticosteroid tapering; 3) Long-term management should integrate lesion assessment, laboratory monitoring, and psychological intervention. This case offers clinical insights into this rare comorbidity and highlights BP induction risks associated with immunomodulatory therapies. Psoriasis Bullous Pemphigoid Glucocorticoids Methotrexate Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7415434","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":526355559,"identity":"960cc0b4-011b-49c7-9ad6-f53edaa29999","order_by":0,"name":"Weimin Ma","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese PLA","correspondingAuthor":false,"prefix":"","firstName":"Weimin","middleName":"","lastName":"Ma","suffix":""},{"id":526355562,"identity":"73221957-d66b-4196-a93e-896132ba9f0c","order_by":1,"name":"Cheng Li","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese PLA","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Li","suffix":""},{"id":526355563,"identity":"8a09820b-fdc6-4f22-a1da-086109422172","order_by":2,"name":"Haijun Miao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYDAC5oMPGCoYDjDwM4NYRAG2ZAOGM0Atku0gFklaDM7zmAkQpcPgGDPziwO/7iRuPsxgxsBQYxNNjBY2i4N9zxK3HWZIe8BwLC23gZAWs/v9x4w/9hwGaTluwNhwmAgtQFsMDgK1bG5mbJMgVgvzgwM/DiduYGZmI06LPdAWhoMNh41nHGZjNkggxi+SbczMHw78OSzb33/+44MPNTaEtQAB0D1tDI5glQlEKAcB5g8MfxjsiVQ8CkbBKBgFIxEAANHqSr798dbuAAAAAElFTkSuQmCC","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese PLA","correspondingAuthor":true,"prefix":"","firstName":"Haijun","middleName":"","lastName":"Miao","suffix":""}],"badges":[],"createdAt":"2025-08-20 08:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7415434/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7415434/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93151332,"identity":"d9720401-3e64-450a-9646-3f858244b9db","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32353,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedManuscriptCleanVersion.docx","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/8cf2b245175bd7872d44e2f8.docx"},{"id":93151333,"identity":"eb897f77-4d5e-409b-b574-f41a31220419","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4613,"visible":true,"origin":"","legend":"","description":"","filename":"b473d788a490410b954b0667def26778.json","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/ad94281b312096b2f5129be7.json"},{"id":93151337,"identity":"47d7b8d5-ade5-43d8-990b-91801e61f0cf","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":473626,"visible":true,"origin":"","legend":"","description":"","filename":"InformedConsentCaseReport.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/66a4a7be552eebd70d5ac174.pdf"},{"id":93151338,"identity":"be153470-45bd-4d44-a80b-657aa4476382","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":386996,"visible":true,"origin":"","legend":"","description":"","filename":"TheHospitalsCaseRegistrationRecord.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/5c8abcfb7574aca16cb5cfc7.pdf"},{"id":93151339,"identity":"0d97e984-7a7d-4a4f-8008-22f5d521e439","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":46013,"visible":true,"origin":"","legend":"","description":"","filename":"b473d788a490410b954b0667def267781enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/d818df65a975fa166e682d99.xml"},{"id":93151334,"identity":"c1f39359-d71e-4e89-bae3-7e407074ab49","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45023,"visible":true,"origin":"","legend":"","description":"","filename":"b473d788a490410b954b0667def267781structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/ff4c657d898a6717eaa95451.xml"},{"id":93151336,"identity":"ae3decd8-2fe0-47e2-8bbe-3af49bcf5e46","added_by":"auto","created_at":"2025-10-09 14:44:55","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50914,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1/96607bd3023020bb80f2e9f2.html"},{"id":95193812,"identity":"701f0740-b39d-49a8-94cd-ba008d4534b9","added_by":"auto","created_at":"2025-11-05 10:54:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":347109,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedManuscriptCleanVersion.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7415434/v1_covered_9992f175-574a-4b1a-afa5-296e6b2247a5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Glucocorticoids Combined with Methotrexate in the Treatment of Psoriasis Merged with Bullous Pemphigoid: A Case Report and Literature Review","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Psoriasis, Bullous Pemphigoid, Glucocorticoids, Methotrexate","lastPublishedDoi":"10.21203/rs.3.rs-7415434/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7415434/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eThis case report describes the diagnosis and treatment of a 64-year-old male patient with psoriasis complicated by Bullous Pemphigoid (BP). The patient developed new-onset tension blisters on chronic psoriatic plaques, with coexistence confirmed by histopathology and direct immunofluorescence. A combined regimen of methylprednisolone and methotrexate resulted in the complete extinction of skin lesions after three months. Literature integration revealed: 1) Th17/Th2 immune imbalance is a pivotal mechanism, where IL-17A may degrade BP180 antigen via MMP-9 upregulation; 2) Early corticosteroid-immunosuppressant therapy effectively controls disease activity, yet 30\u0026ndash;40% of patients relapse during corticosteroid tapering; 3) Long-term management should integrate lesion assessment, laboratory monitoring, and psychological intervention. This case offers clinical insights into this rare comorbidity and highlights BP induction risks associated with immunomodulatory therapies.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Glucocorticoids Combined with Methotrexate in the Treatment of Psoriasis Merged with Bullous Pemphigoid: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-09 14:44:51","doi":"10.21203/rs.3.rs-7415434/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"385fbf8a-6434-440b-ba9e-30064d0d9c64","owner":[],"postedDate":"October 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T10:54:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-09 14:44:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7415434","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7415434","identity":"rs-7415434","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}