Rapid Communication| Volume 31, ISSUE 9, P1987-1990, September 2009

A case of linear immunoglobulin A bullous dermatosis in a patient exposed to sun and an analgesic

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      Background: Medications are the most common triggers of linear immunoglobulin A bullous dermatosis (LABD). LABD induced by ultraviolet (UV) radiation has rarely been described. This article reports a case of LABD in a patient exposed simultaneously to an analgesic and UV radiation.
      Case summary: A 45-year-old woman developed LABD lesions on sun-exposed skin after 3 days of sunbathing and consumption of a medication for headache containing propyphenazone, butalbital, and caffeine. The lesions spread to unexposed skin and, by day 5, the patient had vesicles and bullae on the palms and soles, face, trunk, and extremities. LABD was diagnosed with direct and indirect immunofluorescence microscopy and Western blot analysis. Treatment was successful with prednisone, started at a dosage of 1 mg/kg/d, for 5 months. Lesions located on sunexposed areas, the absence of relapse for 5 years despite continuing sun exposure against medical advice, and subsequent avoidance of the suspected medication suggest that the bullous flare may have been due to the concomitant action of 2 triggers. That the analgesic had a role in this cutaneous manifestation is possible according to the Naranjo algorithm for adverse drug reactions.
      Conclusions: A case of LABD possibly associated with sun exposure and an analgesic is described. Treatment with prednisone successfully resolved the lesions in this patient.

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        • Guide SV
        • Marinkovich MP
        Linear IgA bullous dermatosis.
        Clin Dermatol. 2001; 19: 719-727
        • Onodera H
        • Mihm Jr, MC
        • Yoshida A
        • Akasaka T
        Druginduced linear IgA bullous dermatosis.
        J Dermatol. 2005; 32: 759-764
        • McEvoy MT
        • Connolly SM
        Linear IgA dermatosis: Association with malignancy.
        J Am Acad Dermatol. 1990; 22: 59-63
        • Hayakawa K
        • Shiohara T
        • Yagita A
        • Nagashima M
        Linear IgA bullous dermatosis associated with rheumatoid arthritis.
        J Am Acad Dermatol. 1992; 26: 110-113
        • Paige DG
        • Leonard JN
        • Wojnarowska F
        • Fry L
        Linear IgA disease and ulcerative colitis.
        Br J Dermatol. 1997; 136: 779-782
        • Salmhofer W
        • Soyer HP
        • Wolf P
        • et al.
        UV light-induced linear IgA dermatosis.
        J Am Acad Dermatol. 2004; 50: 109-115
        • Bruley C
        • Gauchy O
        • Beltzer-Garelly E
        • Binet O
        Dermatose a IgA linèaire photo-aggravèe.
        Ann Dermatol Venereol. 1987; 114: 1358-1359
        • He C
        • Xu H
        • Xiao T
        • et al.
        Localized linear IgA dermatosis induced by UV light-treatment for herpes zoster.
        Int J Dermatol. 2007; 46: 500-502
        • Su H
        • Reano A
        • Viac J
        • Thivolet J
        Comparative expression of bullous pemphigoid antigens in normal human epidermis and cultured keratinocytes.
        Clin Immunol Immunopathol. 1989; 51: 406-413
        • Bigby M
        • Stern R
        Cutaneous reactions to nonsteroidal anti-inflammatory drugs. A review.
        J Am Acad Dermatol. 1985; 12: 866-876
        • Himly M
        • Jahn-Schmid B
        • Pittertschatscher K
        • et al.
        IgEmediated immediate-type hypersensitivity to the pyrazolone drug propyphenazone.
        J Allergy Clin Immunol. 2003; 111: 882-888
        • Ruocco V
        • Sacerdoti G
        Pemphigus and bullous pemphigoid due to drugs.
        Int J Dermatol. 1991; 30: 307-312
        • Smith JB
        • Hogan DJ
        • Gaspari AA
        Cutaneous reactions to nonsteroidal anti-inflammatory drugs. Author's reply.
        J Am Acad Dermatol. 1995; 33: 320-321
        • Naranjo CA
        • Busto U
        • Sellers EM
        • et al.
        A method for estimating the probability of adverse drug reactions.
        Clin Pharmacol Ther. 1981; 30: 239-245
        • Stein KR
        • Scheinfeld NS
        Druginduced photoallergic and phototoxic reactions.
        Expert Opin Drug Saf. 2007; 6: 431-443