minocycline and Pemphigoid--Benign-Mucous-Membrane

The aim of this study was to evaluate the therapeutic benefit of minocycline in mucous membrane pemphigoid (MMP) predominantly involving the oral cavity. A descriptive, open clinical study with no control group, including 9 patients, was developed. The diagnosis was confirmed by histopathological examination and direct and salt-split-skin indirect immunofluorescence analysis. Target antigens were sought by immunoblotting. Patients received minocycline (200mg/day) for a variable period. All patients were followed up for at least 2 years after initial diagnosis. Therapeutic response was assessed by clinical improvement in three categories: major response, minor response and no response. A major response was observed in 3 patients (33%), a minor response in 4 (44%) and 2 (22%) patients showed no improvement. Two of the 3 patients with a major response showed no immunoblot reactivity; 80% of patients with circulating autoantibodies (autoAb) against BP180 had a minor or no response. Permanent remission of signs with no relapse was only obtained in one patient. 5 patients (55%) stopped the drug because of adverse effects, such as vertigo and gastralgia. The results revealed temporary clinical benefits in MMP predominantly involving the oral cavity with minocycline, although frequently side effects led to drug withdrawal.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Clobetasol; Complement C3; Drug Combinations; Female; Fluorescent Antibody Technique, Indirect; Gingival Diseases; Glucocorticoids; Humans; Immunoglobulin A; Immunoglobulin G; Middle Aged; Minocycline; Pemphigoid, Benign Mucous Membrane; Treatment Outcome; Vertigo

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Antibodies; Biomarkers; Cell Adhesion Molecules; Drug Therapy, Combination; Fatal Outcome; Female; Glucocorticoids; Graft vs Host Disease; Humans; Immunocompromised Host; Kalinin; Leukemia, Myeloid, Acute; Minocycline; Pemphigoid, Benign Mucous Membrane; Recurrence

Cicatricial pemphigoid is a rare autoimmune blistering disease of the elderly. It predominantly affects the mucosae, causing pain and scarring. the target antigen is within the lamina lucida of the basement membrane zone. Potential complications of systemic steroid and other immunosuppressive therapy have prompted trials of other means of treatment. We describe a series of seven patients treated with minocycline, six of whom derived sustained alleviation of orodynia. Four patients developed hyperpigmentation, and two complained of gastrointestinal discomfort which necessitated cessation of minocycline. Complete steroid withdrawal was achieved in two cases. Neither the disease progression nor the response to treatment was influenced by the immunoglobulin isotype or titre. The role of minocycline as a useful adjunct to therapy is discussed.

Topics: Aged; Female; Humans; Immunoglobulin A; Immunoglobulin G; Male; Middle Aged; Minocycline; Mouth; Mouth Diseases; Palate, Soft; Pemphigoid, Benign Mucous Membrane