tetracycline and Pemphigoid--Benign-Mucous-Membrane

We have previously reported the reduction of cicatricial pemphigoid orodynia with minocycline. Tetracycline combined with high dose nicotinamide has also been beneficial in a number of cutaneous immunological disorders. We now report a series of eight cases in whom further subjective or clinical improvement accrued in five, after the addition of high dose (2.5 or 3 g) nicotinamide to minocycline; however, one of these then discontinued the nicotinamide because of headache and nausea, another was withdrawn from the study because of progressive upper respiratory tract mucosal involvement, and two were changed from minocycline to tetracycline because they developed minocycline-induced hyperpigmentation.

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Niacinamide; Pemphigoid, Benign Mucous Membrane; Tetracycline; Treatment Outcome

We describe a case of cicatricial pemphigoid in a 92-year-old female with extensive mucocutaneous involvement. She developed extensive hemorrhagic blistering with severely bleeding lesions, that healed with scarring. The conjunctivae showed extensive synechia. The diagnosis was based on clinical and histopathological features as well as immunofluorescence findings and immunoblot analysis. There was no clinical response to topical corticosteroids. The patient was given tetracycline and nicotinamid and showed rapid improvement of the mucocutaneous lesions within a few weeks. The clinical features, differential diagnosis and various treatment modalities of cicatricial pemphigoid are briefly reviewed, whereby the use of tetracycline and nicotinamide is discussed as an alternative effective and safe therapy for this potentially incapacitating condition.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Therapy, Combination; Ear, External; Female; Follow-Up Studies; Humans; Niacinamide; Pemphigoid, Benign Mucous Membrane; Skin; Tetracycline; Time Factors

Cicatricial pemphigoid (CP) is one of the subepidermal autoimmune bullous dermatoses in which pathologic separation occurs between the epidermis and dermis. Ocular findings characteristic of CP include conjunctival cicatrization, subepithelial fibrosis, and symblepharon formation, which may progress to blindness. Ocular CP (OCP) is usually treated with steroids or immunosuppressive agents, which are problematic in and of themselves within the elderly population, which is most often afflicted with OCP. We describe the utility and effectiveness of therapy with tetracycline and niacinamide in elderly patients with OCP.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anti-Bacterial Agents; Conjunctival Diseases; Diagnosis, Differential; Female; Humans; Niacinamide; Pemphigoid, Benign Mucous Membrane; Tetracycline

Topics: Administration, Topical; Aged; Humans; Male; Mouth Diseases; Mouthwashes; Pemphigoid, Benign Mucous Membrane; Tetracycline