Pemphigus

Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis, angioedema, urticaria, various skin disorders, such as lichen planus or keloids... 

R. Caputo, L. Mangoni, P. Monaco, G. Palumbo, Triterpenes of galls of Pistacia terebinthus galls produced by Pemphigus utricularius, Phytochemistry, 14, 809 811 (1975). 

Pemphigus Flaccid bullae, chest Present or absent Penicillamine,captopril, piroxicam, penicillin, rifampin Supportive0... 

Landau, M. and Brenner, S., Histopathologic Hndings in drug-induced pemphigus, Amer. J. Dermatopathol., 19, 411, 1997. 

Brenner, S., Bialy-Golan, A., and Ruocco, V., Drug-induced pemphigus, Clin. Dermatol., 16, 393,1998. 

Methyldopa Autoimmune hemolytic anemia, leukopenia, drug-induced SLE, pemphigus... 

Nitrofurantion D-Penicillamine Peripheral neuritis Autoimmunity drug-induced SLE, myasthenia gravis, pemphigus, glomerulonephritis, Goodpasture s disease... 

Propranolol Procainamide Pyrithioxine Autoimmunity Autoimmunity, drug-induced SLE, rash, vasculitis, myalgias Pemphigus... 

Sulfonamides Dermatitis, photosensitivity pemphigus, hemolytic anemia, serum sickness, drug-induced SLE... 

Although rare, cases of renal lupus syndrome and pemphigus blisters have also been reported as a consequence of D-penicillamine-induced immune complexes (Ntoso et al., 1986 Bigazzi, 1988), as well as with other drugs. With renal lupus syndrome, secondary glomerulonephritis may result if granular IgG antibodies are produced and deposited on the basement membranes. In patients with pemphigus blisters, autoantibodies to the intercellular substance of the skin have been recovered from the sera, and dermal biopsies have demonstrated intracellular deposits or... 

Mimouni D, Anhalt GJ, Cummins DL, Kouba DJ, Thome JE, Nousari HC. (2003) Treatment of pemphigus vulgaris and pemphigus foliaceus with mycophenolate mofetil. Arch Dermatol 139 739-742. 

Dermatologic diseases Pemphigus bullous dermatitis herpetiformis severe erythema multiforme (Stevens-Johnson syndrome) mycosis fungoides severe psoriasis angioedema or urticaria exfoliative, severe seborrheic, contact, or atopic dermatitis. 

Hepatotoxicity Penicillamine has been associated with a mild elevation of hepatic enzymes that usually returns to normal even with continuation of the drug. Autoimmune syndromes Autoimmune syndromes that may be caused by penicillamine include polymyositis, diffuse alveolitis and dermatomyositis, Goodpasture s syndrome, myasthenic syndrome, pemphigus, and obliterative bronchiolitis. 

Alternative/Adjunctive treatment Psoriasis, seborrheic dermatitis, severe diaper rash, dishidrosis, nodular prurigo, chronic discoid lupus erythematosus, alopecia areata, lymphocytic infiltration of the skin, mycosis fungoides, and familial benign pemphigus of Hailey-Hailey. 

Aluminum acetate is a topical agent used as an antiseptic including suppurating superficial wounds and tropical ulcers, and the lesions produced by pemphigus and impetigo. 

Topical corticosteroids are most useful in inflammatory dermatoses, such as eczematous dermatitis and psoriasis they may also be helpful in other skin diseases that have a prominent inflammatory component, such as autoimmune blistering diseases (e.g., bullous pemphigoid and pemphigus vulgaris) and lupus erythematosus. 

When CNS involvement occurs, the poor penetration of suramin and pentamidine into the CSF requires alternative forms of chemotherapy, such as melarsoprol in combination with suramin. In treating Onchocerca volvulus infections, suramin kills adult worms and is an alternative to ivermectin. Suramin is used after initial treatment with diethylcarbamazine, which is used to kill the microfilariae. It produces favorable results in pemphigus and prolongs the time to disease progression in hormone-refractory prostate cancer. 

Unlabeled Uses Treatment of pemphigus, psoriatic arthritis... 

Unlabeled Uses Treatment of biliary cirrhosis, chronic acfive hepatitis, glomerulonephritis, inflammatory bowel disease, inflammatory myopathy, multiple sclerosis, myasthenia gravis, nephrotic syndrome, pemphigoid, pemphigus, polymyositis, systemic lupus erythematosus... 

Skin diseases Atopic dermatitis, dermatoses, lichen simplex chronicus (localized neurodermatitis), mycosis fungoides, pemphigus, seborrheic dermatitis, xerosis... 

Antimetabolites Psoriasis, pemphigus, pemphigoid See also Chapter 54. 

Corticosteroids Pemphigus, pemphigoid, lupus erythematosus, allergic contact dermatoses, and certain other dermatoses See also Chapter 39. 

Dapsone Dermatitis herpetiformis, erythema elevatum diutinum, pemphigus, pemphigoid, bullous lupus erythematosus See also Chapter 47. 

---