Successful monotherapy of pemphigus vegetans with minocycline and nicotinamide.
J Eur Acad Dermatol Venereol
; 31(1): 85-88, 2017 Jan.
Article
de En
| MEDLINE
| ID: mdl-27600093
ABSTRACT
BACKGROUND:
Pemphigus vegetans is a rare variant of pemphigus vulgaris, accounting for 1-2% of all pemphigus diseases. Systemic corticosteroids are the therapy of first choice in combination with immunosuppressants as steroid-sparing agents.OBJECTIVE:
To highlight the exceptional but successful use of minocycline/nicotinamide monotherapy in pemphigus vegetans.METHODS:
A review of the literature to date about pemphigus vegetans with special emphasis on therapy was performed. Due to its rarity, multiple anecdotal reports without long-term follow-up are available and prospective controlled trials are lacking. Only one retrospective study from Tunisia includes 17 patients with pemphigus vegetans.RESULTS:
We present a 76-year-old woman with pemphigus vegetans achieving complete response to a minocycline/nicotinamide monotherapy at onset and at relapse of the disease. Treatment has been discontinued after repeated direct immunofluorescence (DIF) of previously affected normal skin and anti-desmoglein 3 antibodies had become negative. In addition, DIF of previously involved oral mucosa was negative. During long-term follow-up clinical remission has been maintained for more than 5 years. Up to now, negative results of serial performed indirect immunofluorescence and desmoglein ELISA testing also predict immunological remission.CONCLUSION:
In our patient and in a case with oesophageal involvement, published more than 20 years ago, clearly the benefit of minocycline/nicotinamide monotherapy was demonstrated. We propose to consider minocycline/nicotinamide as first-line monotherapy in pemphigus vegetans, especially in elderly patients with comorbidities and contraindications to standard therapy, as it avoids the toxicities of systemic corticosteroids and immunosuppressants.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Pemphigus
/
Nicotinamide
/
Minocycline
Type d'étude:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limites:
Aged
/
Female
/
Humans
Langue:
En
Journal:
J Eur Acad Dermatol Venereol
Sujet du journal:
DERMATOLOGIA
/
DOENCAS SEXUALMENTE TRANSMISSIVEIS
Année:
2017
Type de document:
Article
Pays d'affiliation:
Allemagne