Juvenile Pemphigus Foliaceus in a Patient With Psoriasis Receiving Narrow-Band Ultraviolet-B: Successful Treatment With Rituximab

Pemphigus foliaceus is an autoimmune blistering disease of the skin that is not frequently associated with mucous membrane involvement. It is characterized by immunoglobulin G (IgG) antibodies against desmoglein-1, a component of epidermal intercellular adhesion, in the granular layer of the epidermis. Pemphigus foliaceus consists of scattered, arcuate, crusted erythematous lesions often in a seborrheic distribution that may progress to diffuse skin involvement and exfoliative erythroderma. Several cases in the literature discuss pemphigus foliaceus arising in patients with pre-existing psoriatic disease following treatment with narrow-band ultraviolet-B (NB-UVB) therapy. Although this is a rare occurrence and the exact mechanism of this phenomenon remains unclear, providers should be aware of this association to better improve management and care. We present a case of a 16-year-old-male who developed pemphigus foliaceus following NB-UVB treatment for psoriasis.