Ustekinumab associated bullous pemphigoid in a psoriasis patient and a review of the literature

Ustekinumab is a Food and Drug Administration-approved (2009) novel treatment for psoriasis patients. This anti-interleukin-12/23p40 monoclonal antibody is effective in the treatment of plaque psoriasis and psoriatic arthritis. Several drugs, including anti-tumor necrosis factoralpha agents, used for psoriasis have been reported to induce or cause bullous pemphigoid (BP). A psoriasis patient presented with bullous lesions appearing on the extremities, groin, and axillary region four weeks after ustekinumab therapy. The patient was diagnosed with druginduced BP. Ustekinumab was discontinued and the patient was treated with topical steroids and acitretin. The BP lesions did not recur in the twelve-month follow-up, after cessation of the steroids. Even though several drugs are related to the induction of BP, ustekinumab is included in this list recently. The resolution of BP after discontinuation of ustekinumab favors the diagnosis of drug-induced BP.