tetracycline and Pemphigus

Pemphigus is a rare autoimmune bullous disorder. Numerous treatment regimens have been proposed in the literature.. To assess the efficacy and tolerance of treatment regimens proposed in pemphigus vulgaris (PV) and pemphigus foliaceus (PF), from a systematic review of the literature.. Randomized control trials have been identified using the PubMed and Embase databases up to April 2009. Uncontrolled prospective and retrospective studies have also been analyzed.. Eleven randomized control trials having included a total number of 421 patients (377 PV, 44 PF) have been analyzed. Most studies had a limited statistical power due to the rather low number of cases included. Results from ten different treatment regimens have been analyzed: different dosages of prednisone and prednisolone, pulse intravenous dexamethasone, azathioprine, cyclophosphamide, cyclosporine, dapsone, mycophenolate mofetil, plasmapheresis, topical applications of epidermal growth factor (EGF), and intravenous immune globulins (IVIG). Inclusion criteria were: (i) consecutive patients in nine studies, (ii) patients who did not respond to low doses of corticosteroids in one study, and (iii) patients with relapsing type of pemphigus in one study. None of these studies allowed identifying the best effective and well tolerated regimen. Mycophenolate mofetil was more effective than azathioprine for disease control (from one study; n=40; OR=0.72; 95% CI=0.52-0.99). However, no difference in the rate of clinical remission was evidenced between these drugs. Azathioprine and cyclophosphamide seem to have a corticosteroid sparing effect.. Data from the literature did not allow identifying the best therapeutic regimen, mainly because of the lack of statistical power of most studies. The usefulness of immunosuppressant added to systemic corticosteroids as the first line of treatment is not clearly established.

Topics: Adrenal Cortex Hormones; Combined Modality Therapy; Drug Therapy, Combination; Epidermal Growth Factor; Gold Compounds; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Meta-Analysis as Topic; Multicenter Studies as Topic; Niacinamide; Paraneoplastic Syndromes; Pemphigus; Plasma Exchange; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Retrospective Studies; Tetracycline

Pemphigus is an autoimmune skin disease that can present in a variety of forms and can be a challenging disease to manage and treat. An overview of the different forms of pemphigus and diagnostics are discussed including pemphigus foliaceus (PF), pemphigus erythematosus (PE), panepidermal pustular pemphigus (PPP), pemphigus vulgaris (PV) and paraneoplastic pemphigus (PNP). Emphasis on therapy is presented. Included are the most current commonly used therapeutics (glucocorticoids, azathioprine, chlorambucil and tetracycline and niacinamide); current alternative therapeutics (cyclosporin and tacrolimus and mycophenolate mofetil) and additional alternative therapeutics (cyclophosphamide, chrysotherapy, dapsone, sulfasalazine and intravenous immunoglobulin (IVIG) therapy).

Topics: Animals; Antirheumatic Agents; Azathioprine; Chlorambucil; Cyclophosphamide; Cyclosporine; Dapsone; Dog Diseases; Dogs; Glucocorticoids; Immunoglobulins, Intravenous; Mycophenolic Acid; Niacinamide; Organogold Compounds; Pemphigus; Sulfasalazine; Tacrolimus; Tetracycline

Tetracycline is an antibiotic which has been proven beneficial as an immunomodulating drug in the treatment of autoimmune bullous diseases.. Thirteen hospitalized patients with pempigus vulgaris received tetracycline 2 g/day for 1 month, then 1 g/day for the following 4 weeks. Prednisone 0.5-1 mg/kg/day was then gradually reduced. The control group consisted of seven patients with pemphigus who had received prednisone and azathioprine.. A total of 13 patients in the study group achieved cessation of new blister formation within 5.4 days, compared to 23.71 days (p < 0.0001). The average initial dose of prednisone was 76.53 mg/day for the study group and 118.57 mg/day in the control group (p < 0.014). The average number of days before reduction of the prednisone dosage could begin was 16.53 days for the study group compared to 31.28 days in the control (p < 0.049). Total hospitalization time was also significantly lower: 34.07 days (p < 0.001). The clinical response was not linked to the location of lesions nor to severity of disease.. Tetracycline was shown to be effective as an adjuvant therapy for pemphigus with low toxicity and safety.

Topics: Adult; Anti-Bacterial Agents; Azathioprine; Chemotherapy, Adjuvant; Drug Therapy, Combination; Female; Gastrointestinal Diseases; Glucocorticoids; Hospitalization; Humans; Immunosuppressive Agents; Male; Middle Aged; Pemphigus; Prednisone; Severity of Illness Index; Skin; Tetracycline; Time Factors; Treatment Outcome

Topics: Adult; Aged; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Niacinamide; Pemphigus; Tetracycline

Topics: Acitretin; Adalimumab; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Colchicine; Dapsone; Drug Therapy, Combination; Humans; Immunoglobulin A; Keratolytic Agents; Pemphigus; Prednisone; Tetracycline; Tubulin Modulators

The twin goals of long-term disease control and minimizing toxicities related to immunosuppression necessitate efforts to find effective steroid-sparing agents in the management of patients with autoimmune bullous diseases. Pemphigus especially requires a long view, because the disease can persist throughout a patient's lifetime, yet few clinical trial reports exist to guide the practitioner.. We review the response of pemphigus patients to tetracycline, doxycycline, or minocycline plus niacinamide (TCN/NAM) as steroid-sparing therapy and to determine the effects of TCN/NAM on autoantibody levels during the long-term treatment of pemphigus.. This was a retrospective chart review in a private medical dermatology practice setting of all pemphigus patients treated between 1993 and 2013. Clinical responses to TCN/NAM therapy after initial high-dose steroid induction therapy and pemphigus antibody levels were recorded over the course of disease flares and treatment cycles along with any related side effects. Anti-desmoglein 1 and 3 titers were compared in a subset of patients over time, and a statistical analysis was performed to correlate the clinical response with antibody levels.. Fifty-one pemphigus patients (43 with pemphigus vulgaris, 7 with pemphigus foliaceous, and 1 with pemphigus erythematosus) received at least 3 months of TCN/NAM, and 16 patients with pemphigus vulgaris had 1 set of pemphigus antibody titers correlating to a baseline/flare and clinical remission. TCN/NAM was associated with disease control in 43 of 51 patients, with a duration of response ranging from 1 to 13 years (mean, 3.14 ± 2.97 years). Thirteen of 51 patients needed no additional treatment for complete disease control, while 33 of 51 needed intermittent topical clobetasol or short courses of oral steroids for long-term management. There were 5 nonresponders. Antidesmoglein titers trended lower in TCN/NAM responders, but only desmoglein 3 approached statistical significance (anti-desmoglein 1, P = .21; anti-desmoglein 3, P = .02).. This is a retrospective analysis from a single practice. A lack of serial autoantibody titers limited statistical analyses.. TCN/NAM may be useful as a steroid-sparing therapy for pemphigus.

Topics: Anti-Inflammatory Agents; Clobetasol; Doxycycline; Drug Therapy, Combination; Humans; Minocycline; Niacinamide; Pemphigus; Retrospective Studies; 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

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

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Drug Therapy, Combination; Facial Dermatoses; Humans; Male; Middle Aged; Niacinamide; Nose; Pemphigus; Tetracycline

A 50-year-old Japanese woman visited our clinic, complaining of generalized erythema with painful erosions and bullae. The histopathological findings of the skin lesion suggested development of impetigo. Gentamycin-resistant Staphylococcus aureus was detected by the bacterial culture examination from the impetiginous bullae. A direct immunofluorescence study of the lesion showed an intercellular deposition of IgG and C3 in the upper epidermis. We diagnosed this case as pemphigus foliaceus associated with bullous impetigo. A combined oral administration of tetracycline (200 mg/day) and nicotinamide (1200 mg/day) for 3 weeks was successful. In Japan, patients with moderate to severe symptoms of pemphigus foliaceus are usually treated with oral steroid therapy. To our knowledge, however, there is no reported pemphigus case which has been successfully treated only with tetracycline and nicotinamide.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Impetigo; Middle Aged; Niacinamide; Pemphigus; Tetracycline

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Contraindications; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Niacinamide; Pemphigus; Steroids; Tetracycline

Drug-induced pemphigus represents a diagnostic challenge, as usually no clinical feature differentiates it from its idiopathic counterpart. It was suggested recently that some histologic features may assist in diagnosing drug-associated diseases. The purpose of the study was to determine whether the histologic criteria suggested in the literature are specific enough to arouse suspicion of drug-induced pemphigus. Biopsy specimens of drug-induced and idiopathic pemphigus were reviewed by five dermatologists with no clinical data available about the patients. The sections were assessed to the presence of spongiosis with eosinophils, vacuolar degeneration, and the degree of acantholysis and cleavage level. Using the suggested criteria, the reviewers were unable to confirm a diagnosis of drug-induced pemphigus. It is advisable to consider drug etiology in every case of newly diagnosed pemphigus based on clinical criteria an detailed drug consumption history, as histologic features do not differentiate between drug-associated and idiopathic disease.

Topics: Acantholysis; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Cloxacillin; Diagnosis, Differential; Dipyrone; Drug Eruptions; Drug Therapy; Eosinophils; Female; Humans; Keratinocytes; Male; Medical History Taking; Middle Aged; Necrosis; Pemphigus; Penicillins; Tetracycline; Vacuoles

Topics: Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Female; Humans; Immunoglobulin A; Male; Middle Aged; Niacinamide; Pemphigus; Skin Diseases, Vesiculobullous; 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

The introduction of corticosteroids into oral medicine heralded a therapeutic advance, and substantial benefits have occurred from their use. Three topical steroids are being used currently in oral diseases, i.e. hydrocortisone hemisuccinate, triamcinolone in Orabase 0-1 per cent and betamethasone valerate 0-1 mg. The efficacy of these agents can be increased markedly if they are administered during the prodromal phase of ulceration, i.e. when lymphocyte activity is at its maximum. Therapeutic doses of all of them can be exceeded three times without impairing adrenal function. Nevertheless some of these preparations, as exemplified by topical medication, induced an unfortunate acute pseudomembranous candidiasis without any alteration in the plasma cortisol level. The routine examination and treatment of ulcers in the mouth should be a careful exercise helped by a good light source and a tongue spatula. Oral lesions affecting the soft tissues may be often difficult to diagnose, because of the rapid occurrence of secondary changes, such as maceration from moisture, abrasion by food and teeth, perhaps, and the existence of erosions and ulcerations from ruptured vesicles or bullae. Thus, diagnosis will depend not only on the grouping and distribution of lesion, but also on its subsequent behaviour. In some cases too there will be associated changes in the facial skin or elsewhere in the body.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Epidermolysis Bullosa; Erythema Multiforme; Herpes Simplex; Humans; Hydrocortisone; Lichen Planus; Lupus Erythematosus, Discoid; Mouth Diseases; Pemphigus; Prednisolone; Prednisone; Recurrence; Stomatitis, Aphthous; Tetracycline; Triamcinolone Acetonide

Topics: Adolescent; Adult; Age Factors; Aged; Amyloidosis; Child; Child, Preschool; Epidermolysis Bullosa; Erythema Multiforme; Erythromycin; Female; Gingivitis, Necrotizing Ulcerative; Hand, Foot and Mouth Disease; Herpangina; Herpes Zoster; Humans; Infant; Middle Aged; Mouth Diseases; Pemphigus; Stomatitis, Aphthous; Tetracycline

Two cases of Lyell's syndrome (toxic necrolysis of the epidermis) are reported on account of their rarity. The differential diagnosis of this form and its aetiopathogenesis and treatment are described.

Topics: Ampicillin; Betamethasone; Child; Dermatitis, Exfoliative; Diagnosis, Differential; Epidermolysis Bullosa; Female; Humans; Hydrocortisone; Pemphigus; Stevens-Johnson Syndrome; Tetracycline

Topics: Adrenal Cortex Hormones; Adult; Aged; Antimalarials; Chlorides; Chlortetracycline; Female; Follow-Up Studies; Humans; Male; Mercury; Middle Aged; Pemphigus; Pregnancy; Prognosis; Quinacrine; Suramin; Tetracycline

Topics: Child; Coal Tar; Female; Fluocinolone Acetonide; Humans; Lupus Erythematosus, Discoid; Pemphigus; Sulfur; Tetracycline

Topics: Child; Coloring Agents; Humans; Leukoplakia; Melanoma; Pathology; Pemphigus; Skin Neoplasms; Staining and Labeling; Tetracycline

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Arsenicals; Child; Diagnosis, Differential; Drug Therapy; Humans; Pemphigus; Sulfanilamide; Sulfanilamides; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Blister; Oleandomycin; Pemphigus; Prednisolone; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Pemphigus; Prednisolone; Protein Synthesis Inhibitors; Tetracycline