A CASE OF GENERALIZED PUSTULAR PSORIASIS FOLLOWED BY BULLOUS DISEASE - AN ATYPICAL CASE OF BULLOUS PEMPHIGOID OR A NOVEL BULLOUS DISEASE

We describe a 31-year-old Japanese woman with generalized pustular pso riasis treated with PUVA who subsequently developed a bullous disease. Throughout the disease course, there was no phase of psoriasis vulgar is. Although several reports describe coexistence of psoriasis vulgari s and bullous disease such as bullous periphigoid, coexistence of gene ralized pustular psoriasis without any phase of psoriasis vulgaris and bullous disease is rare. As for the bullous disease, direct immunoflu orescence study showed IgG and C3 deposition along the basement membra ne zone. Indirect immunofluorescence disclosed IgG antibasement membra ne zone antibodies. Indirect immunofluorescence on 1 mol/l sodium chlo ride-split skin demonstrated linear IgG staining almost exclusively on the dermal side of the split. Western immunoblot analysis revealed th at the antibody was directed to neither epidermolysis bullosa acquisit a antigen nor bullous pemphigoid antigens. Considering the unusual cli nical course, we suspect the possibility of a novel autoimmune blister ing disease.