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Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease that most commonly affects adults older than 60 years, whereas psoriasis vulgaris (PV) is a chronic immune-mediated disease that affects both children and adults. Bullous pemphigoid and PV may coexist with each other as well as with various other internal disorders, which may lead to early death. We report the case of a 35-year-old man with a 15-year history of PV and obesity who developed tense blisters with annular arrangement and normal-appearing perilesional skin localized mainly on the trunk, arms, and legs resembling linear IgA bullous dermatosis. This case demonstrated the development of BP in a patient with chronic PV and metabolic syndrome. Although the nature of this unique coincidence is not clear, methotrexate (MTX) seems to be first-line regimen for such cases.

Serum concentrations of pancreatic glucagon were measured in 40 patients with hyperinsulinemic hypoglycemia. In infants with severe disease the glucagon levels were markedly elevated; lower levels were observed in children with episodic hypoglycemia. During diazoxide treatment and after pancreatectomy, the glucagon levels decreased proportionally to suppression of the insulin secretion. Thus the secretion of glucagon seems to be retained in hyperinsulinism in proportion to the insulin hypersecretion, and an increased glucagon level indicates long duration and severity of hyperinsulinemic hypoglycemia. (J P EDIATR 1995;126:948-51)