tetracycline and Pemphigoid--Bullous

Autoimmune blistering diseases can eventually cause life-threatening complications if left untreated. Although there is no cure for these bullous diseases; their therapy is based on suppressing the immune system to cease the de novo formation of the generated antibodies. The current study aimed to assess the safety and efficacy of using standing alone alternative therapies beyond systemic steroids for management of autoimmune bullous diseases. We searched six literature databases for both randomized and quasi-randomized clinical trials that assessed the efficacy of drugs other than systemic steroids in autoimmune bullous diseases. Outcomes were calculated as odds ratios with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses with a frequentist approach. The network ranking order for 629 bullous pemphigoid patients, from the best to the worst was, clobetasol propionate cream (40 mg; (P-score = .87), clobetasol propionate cream (10-30 mg; P-score = .77), nicotinamide plus tetracycline (P-score = .56), steroids (P-score = .29) and doxycycline (P-score = .01). Limitations of this study are the small sample of the included studies except for blister trial and lack of randomization in most trials. To conclude, Combined doxycycline and nicotinamides are safer and more effective option for extensive bullous pemphigoid patients than the usual use of systemic steroids. For limited disease, topical corticosteroid (40 mg/d) use provides a safer and better response modality than the other proposed treatments.

Topics: Glucocorticoids; Humans; Network Meta-Analysis; Pemphigoid, Bullous; Steroids; Tetracycline

Bullous pemphigoid (BP) is the most common auto-immune bullous disorder. Its treatment is difficult due to high age and comorbidities of affected patients.. To assess the effects of treatments for BP.. Randomized therapeutic trials (RCTs) were identified using an automatic search on Pubmed et Embase until March 2009. Large retrospective series with homogeneous therapeutic management were also selected and analyzed.. Forty-four articles were selected and analyzed, which included nine RCTs with a total of 1007 participants (653 patients were included in two trials). Two RCTs comparing different modalities of systemic corticosteroid therapy failed to show differences in measure of disease control. The addition of plasma exchanges (one RCT) or azathioprine (one RCT) allowed to halve the amount of prednisone required for disease control. A further 3-arms RCT compared plasma exchange or azathioprine plus prednisone, but failed to show significant differences for disease control or mortality of BP. One study compared tetracycline plus nicotinamide with prednisolone, no significant difference for disease response was evidenced. A large controlled clinical trial demonstrated that high doses of very potent topical corticosteroids increased initial disease control and 1-year survival of patients with extensive BP, as compared with oral prednisone. Another RCT compared two regimens of potent topical corticosteroids and a non-inferior rate of BP control was obtained with the mild regimen. Finally, a study comparing two immunosuppressant drugs (azathioprine, mycophenolate mofetil) in addition to prednisone failed to show any difference for disease control, recurrence rate or the cumulated doses of prednisone.. Ultrapotent topical corticosteroids (clobetasol propionate; 20 to 40g/day) are effective treatments for BP with fewer systemic side-effects than oral high-dose corticosteroids. Systemic corticosteroids are effective but doses greater than 0.5mg/kg per day are associated with severe side-effects, including decreased survival. The effectiveness of the addition of plasma exchange or immunosuppressants (azathioprine, mycophenolate mofetil) to systemic corticosteroids has not been established. Combination treatment with tetracycline and nicotinamide needs further validation.

Topics: Aged; Azathioprine; Clobetasol; Combined Modality Therapy; Dapsone; Dose-Response Relationship, Drug; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Meta-Analysis as Topic; Multicenter Studies as Topic; Mycophenolic Acid; Niacinamide; Pemphigoid, Bullous; Plasma Exchange; Prednisone; Randomized Controlled Trials as Topic; Recurrence; Retrospective Studies; Tetracycline

Bullous pemphigoid (BP) is the most common autoimmune blistering disease in the West. Oral steroids are the standard treatment.This is an update of the review published in 2005.. To assess treatments for bullous pemphigoid.. In August 2010 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials), MEDLINE, EMBASE, and the Ongoing Trials registers.. Randomised controlled trials of treatments for participants with immunofluorescence-confirmed bullous pemphigoid.. At least two authors evaluated the studies for the inclusion criteria, and extracted data independently.. We included 10 randomised controlled trials (with a total of 1049 participants) of moderate to high risk of bias. All studies involved different comparisons, none had a placebo group. In 1 trial plasma exchange plus prednisone gave significantly better disease control at 1 month (0.3 mg/kg: RR 18.78, 95% CI 1.20 to 293.70) than prednisone alone (1.0 mg/kg: RR 1.79, 95% CI 1.11 to 2.90), while another trial showed no difference in disease control at 6 months.No differences in disease control were seen for different doses or formulations of prednisolone (one trial each), for azathioprine plus prednisone compared with prednisone alone (one trial), for prednisolone plus azathioprine compared with prednisolone plus plasma exchange (one trial), for prednisolone plus mycophenolate mofetil or plus azathioprine (one trial), for tetracycline plus nicotinamide compared with prednisolone (one trial). Chinese traditional medicine plus prednisone was not effective in one trial.There were no significant differences in healing in a comparison of a standard regimen of topical steroids (clobetasol) with a milder regimen (RR 1.00, 95% 0.97 to 1.03) in one trial. In another trial, clobetasol showed significantly more disease control than oral prednisolone in people with extensive and moderate disease (RR 1.09, 95% CI 1.02 to 1.17), with significantly reduced mortality and adverse events (RR 1.06, 95% CI 1.00 to 1.12).. Very potent topical steroids are effective and safe treatments for BP, but their use in extensive disease may be limited by side-effects and practical factors. Milder regimens (using lower doses of steroids) are safe and effective in moderate BP. Starting doses of prednisolone greater than 0.75 mg/kg/day do not give additional benefit, lower doses may be adequate to control disease and reduce the incidence and severity of adverse reactions. The effectiveness of adding plasma exchange, azathioprine or mycophenolate mofetil to corticosteroids, and combination treatment with tetracycline and nicotinamide needs further investigation.

Topics: Azathioprine; Clobetasol; Combined Modality Therapy; Drug Therapy, Combination; Drugs, Chinese Herbal; Glucocorticoids; Humans; Immunosuppressive Agents; Niacinamide; Pemphigoid, Bullous; Plasma Exchange; Prednisolone; Prednisone; Randomized Controlled Trials as Topic; Tetracycline

Bullous pemphigoid (BP) is a chronic, autoimmune, blistering disease observed primarily in the elderly population. Several clinical variants have been described, including classic (bullous), localised, nodular, vegetating, erythrodermic, erosive, childhood and drug-induced forms. Autoantibodies target the BP230 and BP180 antigens, located in the hemidesmosomal complex of the skin basement membrane zone. Subsequent complement activation recruits chemical and cellular immune mediators to the skin, ultimately resulting in blister formation. Both autoantibodies and complement may be detected by various immunofluorescent, immune electron microscopy and molecular biology techniques. Recent trials suggest that potent topical corticosteroids should be considered as first-line therapy. Tetracycline with or without nicotinamide may benefit a subset of patients with mild BP. Oral corticosteroids should rarely exceed 0.75 mg/kg/day and corticosteroid-sparing agents may be useful for recalcitrant disease.

Topics: Administration, Topical; Anti-Bacterial Agents; Glucocorticoids; Humans; Pemphigoid, Bullous; Tetracycline

Localized forms of bullous pemphigoid have been reported to occur in sites of trauma. The case of a 79-year-old female who developed blisters at the site of an abdominal surgical wound is reported. The diagnosis of bullous pemphigoid was made by histology and immunofluorescence studies. The reported cases of localized bullous pemphigoid associated with surgical wounds are reviewed.

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Pemphigoid, Bullous; Postoperative Complications; Tetracycline; Wound Healing

The combination of nicotinamide and tetracycline has been anecdotally reported to be effective in the treatment of bullous pemphigoid. We conducted a randomized, open-labeled trial comparing the combination of 500 mg of nicotinamide, three times daily, and 500 mg of tetracycline four times daily, with prednisone therapy in 20 patients with bullous pemphigoid. The study was divided between an 8-week acute phase with fixed drug dosages and a 10-month follow-up phase in which study medications were tapered based on patient response.. Eighteen of 20 patients enrolled in the study were treated, two patients were unavailable for follow-up. Twelve patients were treated with the combination of nicotinamide and tetracycline and six patients were treated with prednisone. There were five complete responses, five partial responses, one nonresponder, and one patient with disease progression in the nicotinamide and tetracycline group compared with one complete response and five partial responses in the prednisone group. There were no statistically significant differences in response parameters between the two groups. All five patients in the nicotinamide and tetracycline group receiving long-term follow-up remained disease free during medication tapering, while three patients in the prednisone group had repeated disease flare-ups with steroid tapering. Adverse effects in the nicotinamide and tetracycline group included gastrointestinal upset (two patients) and transient renal failure (one patient). In the prednisone group, there was one occurrence each of hypertension, erosive gastritis, multiple decubitus ulcers, osteomyelitis, deep venous thrombosis, and death related to sepsis. Two patients required insulin therapy for hyperglycemia.. The combination of nicotinamide and tetracycline appears to be a useful alternative to systemic steroids in the treatment of bullous pemphigoid.

Topics: Aged; Aged, 80 and over; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Niacinamide; Pemphigoid, Bullous; Tetracycline

Bullous pemphigoid (BP) is an autoimmune blistering disease associated with preexisting comorbidities and higher mortality. The interest in using therapy other than oral steroids in BP management results from severe complications and increased risk of death. The efficacy of oral doxycycline or whole-body application of topical clobetasol has been proven in randomized controlled trials. The case series study suggested that combination of tetracycline, nicotinamide, and lesionally administered clobetasol may also be useful.. We conducted a clinical 3-year retrospective study of treatment with tetracycline, nicotinamide, and lesionally administered clobetasol (TNC) in comparison to prednisone (P). Out of 106 patients (mean age 78 ± 9.9 years) with newly diagnosed BP, 59 received tetracycline 1.5 g/daily, nicotinamide 1.2 g/daily, and 0.05% lesionally administered clobetasol cream, and 47 patients - prednisone 0.5 mg/kg daily.. The median time to disease control was achieved after 7 days in both groups. At 4 weeks, 93.2% of patients treated with TNC and 89.1% from P group achieved disease control. The median period between complete remission and relapse was 60 days in the TNC group and 90 days in the P group (P = 0.84). At least one relapse within 1 year was noted in 32.1% of patients from the TNC group and 50% from the P group (P = 0.09). The 1-year survival for the TNC and P groups was 83% and 65.9%, respectively (P = 0.04), and the 3-year survival was 71.2% and 48% (P = 0.019), respectively.. Tetracycline and nicotinamide combined with lesionally administered clobetasol is an alternative, effective treatment with better survival rates compared to prednisone in BP.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intralesional; Male; Middle Aged; Niacinamide; Pemphigoid, Bullous; Prednisone; Retrospective Studies; Tetracycline; Time Factors; Vitamin B Complex

Topics: Anti-Bacterial Agents; Blister; Exanthema; Humans; Pemphigoid, Bullous; Tetracycline

Topics: Anti-Bacterial Agents; Exanthema; Humans; Pemphigoid, Bullous; Tetracycline

Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in Western countries and in Israel. Initial disease control is achieved in 60-90% of BP patients within 1-4 weeks of corticosteroid therapy. In the remainder of patients, recalcitrant disease is controlled with additional immunosuppressive treatment.. We aimed to evaluate the rate of BP patients who needed adjuvant therapy to achieve initial disease control and to identify potential predictors for recalcitrant disease.. We conducted a retrospective study of newly diagnosed BP patients who were hospitalized at the Tel Aviv Sourasky Medical Center between the years 2008-2014. We performed statistical analyses to assess the association between clinical factors and failure of initial disease control.. Among 114 hospitalized patients with newly diagnosed BP, 1.8% presented with oral mucosa involvement. Seven patients (6.1%) required systemic agents in addition to corticosteroids to achieve disease control. Hypertension (P = 0.048), involvement of the head region (P = 0.042), and metformin treatment (P = 0.02) were significantly more prevalent among patients with recalcitrant disease.. The low frequency of recalcitrant BP (6.1%) and the rarity of involvement of the oral mucosa (1.8%) in this study suggest that Israeli BP patients present a milder phenotype compared to similar patients from other geographic areas. Hypertension, head involvement, and metformin therapy were found to be significantly associated with the need for adjuvant therapy to achieve initial control, suggesting that these parameters may serve as predictors of treatment response in BP.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Diabetes Mellitus; Drug Therapy, Combination; Female; Head; Hospitalization; Humans; Hypertension; Hypoglycemic Agents; Immunosuppressive Agents; Male; Metformin; Methotrexate; Middle Aged; Pemphigoid, Bullous; Prednisone; Retrospective Studies; Risk Factors; Tertiary Care Centers; Tetracycline; Treatment Failure

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Biopsy; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Fluorescent Antibody Technique, Indirect; Glucocorticoids; Humans; Male; Middle Aged; Niacinamide; Pemphigoid, Bullous; Predictive Value of Tests; Pruritus; Sensitivity and Specificity; Tetracycline; Torso; Treatment Outcome; Vitamin B Complex

Topics: Aged; Autoantibodies; Autoantigens; Carrier Proteins; Causality; Collagen Type XVII; Cytoskeletal Proteins; Diagnosis, Differential; Drug Therapy, Combination; Dystonin; Female; Humans; Immunoglobulin M; Nerve Tissue Proteins; Niacinamide; Non-Fibrillar Collagens; Pemphigoid, Bullous; Scabies; Tetracycline

Topics: Cost-Benefit Analysis; Doxycycline; Humans; Pemphigoid, Bullous; Pragmatic Clinical Trials as Topic; Prednisolone; Research Design; Steroids; Tetracycline; Treatment Outcome; United Kingdom; United States

Topics: Adult; Aged; Aged, 80 and over; Autoantibodies; Autoantigens; Azathioprine; Cohort Studies; Collagen Type XVII; Dermatologic Agents; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Niacinamide; Non-Fibrillar Collagens; Pemphigoid, Bullous; Prednisolone; Remission Induction; Severity of Illness Index; Tetracycline; Treatment Outcome

Pemphigus and pemphigoid are different types of autoimmune bullous disease and can occur in the same patient. We report a female patient with this condition. At first, we diagnosed her with bullous pemphigoid, and we treated her with tetracycline, niacinamide and a topical steroid. Tense bullas disappeared shortly after that, but crusted erythemas mainly on her head and trunk persisted. We examined BP180 and desmoglein 1 enzyme-linked immunosorbent assays, and also histological features, which showed coexistence of bullous pemphigoid and pemphigus foliaceus concurrently. Therefore, we tried prednisolone, which could control both conditions. This case showed that tetracycline and niacinamide could control bullous pemphigoid, but could not control pemphigus foliaceus, and that prednisolone was effective for both conditions.

Topics: Autoantigens; Collagen Type XVII; Desmoglein 1; Drug Therapy, Combination; Female; Humans; Middle Aged; Niacinamide; Non-Fibrillar Collagens; Pemphigoid, Bullous; Pemphigus; Prednisolone; Tetracycline

Topics: Aged; Biopsy, Needle; Chronic Disease; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique, Direct; Follow-Up Studies; Humans; Immunohistochemistry; Niacinamide; Pemphigoid, Bullous; Prednisolone; Prurigo; Pulmonary Eosinophilia; Risk Assessment; Severity of Illness Index; Tetracycline; Treatment Failure

Prodromal bullous pemphigoid (PBP) can be difficult to diagnose. Early recognition in its early stages may decrease the morbidity and progression of the disease. Clinical presentations and current treatments available for PBP will be described.. A retrospective review was performed on 53 patients diagnosed with PBP.. Overall, the average disease duration of PBP was 11.8 months. The average age of presentation of PBP was 70.8 years. The most common presentations were urticaria-like plaques (67.9%), eczema-like lesions (11.3%), and dermatitis herpetiformis-like lesions (9.4%). The majority of patients responded well to low doses of systemic corticosteroids, tetracycline, and/or high potency topical corticosteroids.. Patients with PBP tend to be in their sixth or early seventh decade of life and, on average, the duration of disease is 1 year. The most common presentation of disease is urticaria-like plaques.

Topics: Adult; Aged; Anti-Bacterial Agents; Cohort Studies; Complement C3; Doxycycline; Fluorescent Antibody Technique, Direct; Glucocorticoids; Humans; Immunoglobulin G; Immunosuppressive Agents; Middle Aged; Pemphigoid, Bullous; Retrospective Studies; Tetracycline

Topics: Aged; Anti-Bacterial Agents; Antipruritics; Clobetasol; Female; Humans; Hydroxyzine; Immunosuppressive Agents; Pemphigoid, Bullous; Prednisone; Skin; Tetracycline

We describe a 64-year-old Brazilian man who developed bullous pemphigoid (BP) 12 years after pemphigus foliaceus (PF) was diagnosed. On his first presentation in 1992, histological examination revealed intraepidermal blistering and acantholysis at the granular layer, direct immunofluorescence (DIF) demonstrated intercellular deposits of C3 in the epidermis, and indirect immunofluorescence showed the presence of IgG antibodies against the intercellular spaces. In 2004, laboratory findings revealed a subepidermal blister with neutrophils and eosinophils (by histology), DIF demonstrated deposition of IgG and C3 along the basement membrane zone, salt-split skin showed IgG deposition in the epidermal side of the blister, and immunoblotting showed reactivity against BP180. The occurrence of two autoimmune blistering conditions in the same patient is a rare event, and may suggest an intermolecular epitope-spreading phenomenon.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Autoantibodies; Biopsy; Blister; Fatal Outcome; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Male; Middle Aged; Pemphigoid, Bullous; Pemphigus; Prednisolone; Tetracycline

We report the first case of bullous pemphigoid complicating radiation therapy for vulvar cancer. Shortly after completion of postoperative radiation therapy for a TIN1 vulvar carcinoma, the patient presented with a rash that started within, but continued to extend, well beyond the radiation field. A biopsy of the lesions confirmed the diagnosis of bullous pemphigoid, and she had prompt clinical resolution with systemic tetracycline and steroids.

Topics: Acute Disease; Aged; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Pemphigoid, Bullous; Radiodermatitis; Steroids; Tetracycline; Vulvar Neoplasms

To study the efficacy of tetracycline (or doxycycline) and nicotinamide in the treatment of less extensive bullous pemphigoid.. An open trial of 11 patients with bullous pemphigoid. Treatment was initiated with tetracycline 1.5-2 g/day and nicotinamide 1.5-2 g/day and gradually tapered down. Doxycycline was substituted for tetracycline in patients who could not tolerate tetracycline due to gastrointestinal side effects or headache.. 6 out of 11 patients achieved complete response (> 90% decrease in lesions) while another 2 had partial response (50-90% decrease in lesions).. Tetracycline/doxycycline and nicotinamide is a useful alternative treatment for localized bullous pemphigoid, especially in those whose concurrent medical illnesses preclude the use of systemic corticosteroids.

Topics: Aged; Anti-Bacterial Agents; Complement C3; Diarrhea; Doxycycline; Drug Combinations; Female; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Headache; Humans; Immunoglobulin G; Male; Niacinamide; Pemphigoid, Bullous; Recurrence; Remission Induction; Skin; Tetracycline; Vomiting

Topics: Drug Therapy, Combination; Female; Humans; Lichen Planus; Middle Aged; Niacinamide; Pemphigoid, Bullous; Protein Synthesis Inhibitors; Tetracycline

Pemphigoid is a well-recognized cutaneous lesion, occurring rarely in peristomal skin. We report the diagnosis and successful treatment of localized pemphigoid lesions adjacent to a colostomy.. We review the chart, immunofluorescence study, treatment, and follow-up of a patient with bullous lesions at a colostomy site.. Pemphigoid of the pericolostomy skin was diagnosed by immunofluorescence study and successfully treated with antibiotic.. Diagnosis of bullous pemphigoid should be considered in the differential diagnosis of a bullous lesion adjacent to a colostomy site. Diagnosis is easily made, and treatment is simple and efficacious.

Topics: Aged; Anti-Bacterial Agents; Colostomy; Diagnosis, Differential; Female; Fluorescent Antibody Technique, Direct; Humans; Pemphigoid, Bullous; Tetracycline

Stump pemphigoid is a localized variant of bullous pemphigoid characterized by specific clinical, pathological, and immunofluorescent characteristics. The early diagnosis of this entity guides treatment toward this specific immunologically mediated inflammatory process and away from treatment of unrelated conditions with similar clinical findings.

Topics: Amputation Stumps; Anti-Bacterial Agents; Biopsy; Fluorescent Antibody Technique; Humans; Male; Middle Aged; Niacinamide; Pemphigoid, Bullous; Tetracycline

In 1986, Berk and Lorincz reported the efficacy of tetracycline and nicotinamide in the treatment of bullous pemphigoid (BP). In the present study of seven patients with BP, we found that a regimen of 2 g tetracycline combined with 2 g nicotinamide daily was effective in clearing the skin lesions. Total remission was achieved within 6-8 weeks, after which the dose was gradually tapered. The mean duration of therapy was 7 months. No effect on the titre of antibasement membrane antibodies was observed. The mode of action of this therapy is unknown.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Middle Aged; Niacinamide; Pemphigoid, Bullous; Tetracycline; Treatment Outcome

Topics: Administration, Oral; Aged; Aged, 80 and over; Female; Humans; Pemphigoid, Bullous; Tetracycline

A rare complication occurring in a female patient who underwent conservative surgery and radiation therapy for breast cancer is described. Three weeks after the completion of radiotherapy, a diffuse bullous pemphigoid eruption developed in the irradiated area, spreading thereafter to the whole body. Although systemic cutaneous side effects have been reported after radiation therapy, this is the first occurrence of bullous pemphigoid ever reported in a female patient following treatment for breast cancer. Having made the diagnosis, an effective therapeutic regimen including nicotinamide and tetracycline was started. As the conservative management of breast cancer is now widely adopted, oncologists and physicians should be aware of such rare side effects due to radiation therapy.

Topics: Anti-Bacterial Agents; Breast Neoplasms; Carcinoma, Ductal, Breast; Dermatologic Agents; Female; Humans; Mastectomy, Segmental; Middle Aged; Niacinamide; Pemphigoid, Bullous; Radiation Injuries; Radiotherapy; Tetracycline

Topics: Administration, Oral; Administration, Topical; Drug Therapy, Combination; Humans; Pemphigoid, Bullous; Steroids; Tetracycline; Treatment Outcome

Topics: Administration, Oral; Doxycycline; Humans; Pemphigoid, Bullous; Tetracycline

Although bullous pemphigoid (BP) is a benign self-limited disease, the mainstay of treatment remains systemic steroids, often in combination with immunosuppressive agents. This therapy has considerable potential toxicity, particularly in elderly patients with preexisting problems.. The purpose of this study was to evaluate the efficacy of oral tetracycline as first-choice therapy in patients with BP.. Every patient newly diagnosed with generalized BP was treated with oral tetracycline and a midpotency topical steroid.. In all five patients, blister formation was stopped and reepithelialization completed within 1 to 3 weeks. There was no relapse or toxicity noted; follow-up ranged from 16 to 24 months.. Oral tetracycline was found to be rapidly efficacious in all patients and devoid of toxicity.

Topics: Administration, Oral; Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Drug Therapy, Combination; Fluorescent Antibody Technique; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Pemphigoid, Bullous; Tetracycline

A combination of niacinamide and tetracycline was used to treat 31 dogs with various autoimmune skin diseases (discoid lupus erythematosus, pemphigus foliaceus, pemphigus erythematosus, and bullous pemphigoid). Of the 20 dogs with discoid lupus erythematosus, 70% had excellent or good response to treatment. Serious side effects were not noticed in any dog.

Topics: Animals; Autoimmune Diseases; Dog Diseases; Dogs; Drug Combinations; Female; Lupus Erythematosus, Discoid; Niacinamide; Pemphigoid, Bullous; Pemphigus; Skin Diseases; Tetracycline

Two men with nonscarring, persistent, localized bullous pemphigoid, whose eruption is completely controlled with daily doses of oral tetracycline, are described. A review of the literature on persistent, localized bullous pemphigoid is presented. The effects of tetracycline on leukocytes that may play a role in the response of these patients are discussed.

Topics: Administration, Oral; Aged; Eosinophils; Humans; Male; Middle Aged; Neutrophils; Pemphigoid, Bullous; Skin; Skin Diseases, Vesiculobullous; Tetracycline

Patients with moderate to severe bullous pemphigoid are usually treated with systemic corticosteroids. Four patients were treated with tetracycline hydrochloride and niacinamide because of the steroid-sparing anti-inflammatory properties of these agents. An excellent clinical response free of side effects was observed in all patients. The lesions recurred whenever treatment was discontinued. It is believed that these drugs suppress the complement-mediated inflammatory response at the basement membrane zone by suppressing neutrophil chemotaxis and mediators of the inflammatory response in this bullous disease.

Topics: Administration, Oral; Aged; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Niacinamide; Pemphigoid, Bullous; Skin; Skin Diseases, Vesiculobullous; Tetracycline