minocycline and Pemphigoid--Bullous

Topics: Anti-Bacterial Agents; Biopsy; Blister; Diagnosis, Differential; DNA, Bacterial; Drug Therapy, Combination; Humans; Leprosy; Male; Middle Aged; Minocycline; Mixed Connective Tissue Disease; Mycobacterium; Pemphigoid, Bullous; Polymerase Chain Reaction; Rifampin; Skin

Dipeptidyl peptidase 4 (DPP-4) inhibitors are increasingly used these days in management of diabetes. There has been reported in a few case reports of increasing association between DPP-4 inhibitor use and bullous pemphigoid (BP). We report a case of association between linagliptin use and BP and subsequent treatment with rituximab.

Topics: Aged; Anti-Bacterial Agents; Clobetasol; Dipeptidyl-Peptidase IV Inhibitors; Drug Eruptions; Humans; Linagliptin; Male; Minocycline; Pemphigoid, Bullous; Prednisone; Rituximab; Treatment Outcome

Minocycline/tetracycline is clinically used for the treatment of bullous pemphigoid (BP), and its clinical benefits are superior to those of prednisolone when considering adverse events. Although the clinical benefits of minocycline/tetracycline are well known, its immunosuppressive mechanisms are still unclear. In this study, we investigated the immunomodulatory effects of traditional anti-BP drugs (minocycline, nicotinic acid amide, dexamethasone and cyclosporine) on CD163

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Cells, Cultured; Chemokine CCL17; Chemokine CCL2; Chemokine CCL22; Chemokine CCL24; Chemokine CCL26; Chemokine CXCL10; Chemokines, CC; Dexamethasone; Female; Humans; Macrophages; Male; Middle Aged; Minocycline; Niacinamide; Pemphigoid, Bullous; Pemphigus; Protein Biosynthesis; Receptors, Cell Surface; Vitamin B Complex

Bronchiolitis obliterans is a small-airway obstructive lung disease for which immunologically mediated pathogenesis is supposed. Frequent association of bronchiolitis obliterans with paraneoplastic pemphigus is well known, but its association with other autoimmune bullous diseases has not been reported except for a case of anti-laminin-332-type mucous membrane pemphigoid in a patient with chronic graft-versus-host disease. We report a case of non-paraneoplastic autoimmune subepidermal bullous disease associated with fatal bronchiolitis obliterans in a patient without transplantation. Although the patient's serum contained immunoglobulin (Ig)A antibodies to the 180-kDa bullous pemphigoid antigen/type XVII collagen and IgG antibodies to laminin-332, diagnosis of either linear IgA bullous dermatosis or mucous membrane pemphigoid could not be made because of the failure to detect linear IgA deposition at the basement membrane zone by direct immunofluorescence and the lack of mucous membrane lesions. Physicians should be aware that autoimmune bullous diseases other than paraneoplastic pemphigus can also associate with this rare but potentially fatal lung disease.

Topics: Aged; Anti-Bacterial Agents; Autoantibodies; Autoantigens; Basement Membrane; Biopsy; Bronchiolitis Obliterans; Cell Adhesion Molecules; Collagen Type XVII; Fatal Outcome; Fluorescent Antibody Technique, Direct; Glucocorticoids; Humans; Immunoglobulin A; Immunoglobulin G; Kalinin; Male; Minocycline; Niacinamide; Non-Fibrillar Collagens; Paraneoplastic Syndromes; Pemphigoid, Bullous; Prednisolone; Respiratory Insufficiency; Vitamin B Complex

Topics: Administration, Oral; Anti-Bacterial Agents; Autoantigens; Chemokine CCL17; Collagen Type XVII; Complement C3; Dermatitis, Atopic; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique, Direct; Glucocorticoids; Humans; Immunoglobulin E; Immunoglobulin G; Middle Aged; Minocycline; Non-Fibrillar Collagens; Pemphigoid, Bullous; Prednisolone; Severity of Illness Index; Skin

In this report, we describe an 88-year-old male stroke patient with unilateral bullous pemphigoid limited to the hemiplegic side. Physical examinations revealed multiple tense bullae with clear and/or bloody contents without apparent erythema on the right thigh and lower leg, accompanied by erosions on the right chest. Histopathologically, no eosinophils were infiltrated into and around the subepidermal bullae. Immunofluorescence revealed deposited and circulating immunoglobulin (Ig)G anti-basement membrane zone antibodies. Immunoblot assays using various antigen sources and enzyme-linked immunosorbent assay revealed that IgG antibodies in this case reacted with unique epitopes between NC16a and C-terminal domains on the 120-kDa LAD-1, the extracellular truncated form of BP180. Three observations were unique in our case. First, the distribution of bullae in our patient was limited to the hemiplegic side. Second, there was no apparent erythema clinically and no eosinophilic infiltration histopathologically. Third, the patient achieved remission without the use of oral corticosteroids. The unusual epitopes in this case may contribute to these phenomena.

Topics: Adrenal Cortex Hormones; Aged; Aged, 80 and over; Autoantigens; Collagen Type XVII; Eosinophils; Hemiplegia; Humans; Male; Minocycline; Niacinamide; Non-Fibrillar Collagens; Pemphigoid, Bullous; Stroke

Topics: Aged; Anti-Allergic Agents; Anti-Bacterial Agents; Arylsulfonates; Humans; Immunoglobulin E; Male; Minocycline; Pemphigoid, Bullous; Psoriasis; Sulfonium Compounds

Topics: Aged; Anti-Bacterial Agents; Carbamazepine; Drug Hypersensitivity; Female; Humans; Immunosuppressive Agents; Isoxazoles; Minocycline; Pemphigoid, Bullous; Pharyngitis; Syndrome; Time Factors; Treatment Outcome; Trigeminal Neuralgia; Zonisamide

Topics: Autoantibodies; Autoantigens; Collagen Type XVII; Drug Therapy, Combination; Humans; Immunoglobulin G; Leg Dermatoses; Male; Middle Aged; Minocycline; Non-Fibrillar Collagens; Pemphigoid, Bullous; Prednisolone

We studied the precise correlation between ELISA values for BP180 NC16A and the alternations of disease activity in 5 patients with bullous pemphigoid (BP) during various treatments and tried to answer the question of how we can use ELISA to determine the timing of prednisolone (PSL) tapering. Disease activity in some patients with BP, but not in all, was poorly correlated with ELISA values in short-term follow-up. However, all patients showed a good correlation of disease activity with ELISA values as a whole in long-term follow-up. Three patients with typical BP showed rapid and good responses to PSL for erosion and blister formation. Their ELISA values gradually decreased to 40% of initial values during PSL therapy after four weeks. Two patients with the vesicular type of BP did not show rapid and good responses to PSL for erosion and blister formation. In the cases with the vesicular type of BP, diaphenylsulfone in addition to PSL dramatically improved the clinical symptoms including erosion and blister formation, even though the ELISA values were as high as those before treatment. Relapses did not occur with the tapering of PSL dosage when the ELISA values decreased to 40% of initial values, although they were still not within the normal range.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Autoantibodies; Autoantigens; Collagen Type XVII; Dapsone; Drug Administration Schedule; Enzyme-Linked Immunosorbent Assay; Female; Glucocorticoids; Humans; Male; Middle Aged; Minocycline; Non-Fibrillar Collagens; Pemphigoid, Bullous; Prednisolone

Anti-p200 pemphigoid with autoantibodies against the 200-kD dermal antigen has recently been identified.. Our patient showed small and tense blisters on her face and trunk.. Immunoblotting (IB), using extracts of normal human epidermis and dermal skin, and immunoelectron microscopy (IEM), using normal human skin, were performed using the patient's serum.. IB analysis showed that the patient's serum did not react with 180-kD bullous pemphigoid (BP180) or BP230 antigens; however, IgG autoantibodies in the patient's serum reacted with a 200-kD dermal antigen as well as the 290-kD epidermolysis bullosa acquisita (EBA) antigen. IEM showed that IgG antibodies in the patient's serum bound to the lamina lucida, as well as both the lamina densa and sublamina densa. After the treatment with prednisolone, the 290-kD protein reactivity decreased rapidly; however, the 200-kD protein band was still observed.. We describe a rare case with immunoreactive autoantibodies against both a novel dermal 200-kD autoantigen and the 290-kD EBA antigen.

Topics: Adult; Autoantigens; Biopsy, Needle; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunoblotting; Immunohistochemistry; Microscopy, Immunoelectron; Minocycline; Niacin; Pemphigoid, Bullous; Prednisolone; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Dermatomyositis; Humans; Male; Minocycline; Pemphigoid, Bullous

We present a retrospective analysis of patients with bullous pemphigoid (BP) treated with minocycline in the Department of Dermatology, Churchill Hospital, Oxford between July 1986 and May 2000. More than 200 patients with BP were seen in clinic during the review period. Of these, 22 patients were treated with minocycline, mostly as adjuvant therapy. The response to treatment was assessed by clinical improvement and whether the dose of concurrent immunosuppressive drugs was subsequently reduced. A major response was seen in six patients, a minor response in 11 and no response was seen in five patients. Minocycline was discontinued in four patients because of the occurrence of side-effects. Overall analysis revealed marked clinical benefits of minocycline in BP. However, this is a non-placebo controlled study and should now be followed by a prospective double-blind controlled clinical trial.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Minocycline; Pemphigoid, Bullous; Retrospective Studies; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Immunosuppressive Agents; Minocycline; Niacinamide; Pemphigoid, Bullous; Pregnancy; Pregnancy Complications; Puerperal Disorders; Recurrence

Immunosuppressive medications typically used to treat the immunobullous disorders pemphigus vulgaris, pemphigus foliaceous, and bullous pemphigoid can have serious adverse effects. The tetracycline family of antibiotic drugs has been shown to be effective in the treatment of these conditions with a more favorable side effect profile. Minocycline hydrochloride use has been associated with various forms of hyperpigmentation, and its incidence is well reported in acne vulgaris and rheumatoid arthritis. We examined a series of 9 patients treated with minocycline for pemphigus or pemphigoid, most of whom have developed cutaneous hyperpigmentation.. Seven of 9 patients treated with minocycline, 50 mg daily (1 patient) or 100 mg twice daily (8 patients), for pemphigus vulgaris, pemphigus foliaceous, or bullous pemphigoid developed hyperpigmentation, which necessitated discontinuing therapy. Five of these patients had experienced notable clinical improvement of their immunobullous disease with minocycline therapy. The average duration of treatment was 8.2 months (range, 1-25 months). The second most common adverse effect in our group was oral candidiasis, which occurred in 2 patients.. We found a favorable response to minocycline therapy in 5 of 9 patients. However, 7 patients developed localized hyperpigmentation as early as 1 month after starting medication use. This incidence of minocycline-induced hyperpigmentation is significantly higher in immunobullous disease than in acne vulgaris or rheumatoid arthritis. This increased incidence may be related to an increase in pigment deposition complexed with collagen during the remodeling process, subclinical inflammation, or glucocorticosteroid-induced skin fragility. The hyperpigmentation process was reversible, as most of our patients had fading of their pigmentation after minocycline cessation.

Topics: Adult; Aged; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Pemphigoid, Bullous; Pemphigus; Skin

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Fatal Outcome; Humans; Male; Minocycline; Niacinamide; Pemphigoid, Bullous; Pneumonia; Skin

Pemphigoid vegetans is a rare disease. It has a clinical resemblance to pemphigus vegetans, but there are histological and immunopathological features of bullous pemphigoid.. We describe a case in a 57-year-old-man who had developed intertriginous vegetating plaques. Histologic examination of a skin biopsy specimen and direct immunofluorescence microscopy of a biopsy specimen were those of bullous pemphigoid. Immunoblot studies and indirect immunofluorescences of salt-split skin were negative. Direct immunoelectron microscopy was consistent with bullous pemphigoïd.. Only five cases have been reported. We describe the first case including direct immunomicroscopic findings which suggest that pemphigoid vegetans is a subtype of bullous pemphigoid. The other interest was a remarkable improvement with tetracyclines.

Topics: Anti-Bacterial Agents; Axilla; Humans; Male; Microscopy, Electron; Middle Aged; Minocycline; Pemphigoid, Bullous