Drug-induced pemphigus

Abstract:

Since the mid-20th century, it has been known that drugs can cause or exacerbate pemphigus. Different drugs are suspected as potential causes of drug-induced pemphigus. Some of these drugs induce antibody production, which results in acantholysis, whereas others are inducing acantholysis directly without antibody production. Three groups of chemical structures are suspected to have the potential to cause pemphigus, incuding sulfhydryl radical (thiol drugs and drugs containing sulfur groups (-SH), which then metabolize to thiols), phenol drugs and non-thiol-non-phenol drugs. There is no validated method available to diagnose drug-induced pemphigus, distinguish it from “idiopathic” pemphigus and predict its outcome after withdrawal of the culprit drug(s). The first step in therapy of drug-induced pemphigus is withdrawal of the suspected/offending drug. If the disease does not go into remission, corticosteroids should be introduced. Because of awareness of the possibility that drugs can cause pemphigus, it is important, in each patient diagnosed with pemphigus, to take detailed history of drug intake over the previous months. 

Key words:
acantholysis; antibodies; angiotensin-converting enzyme inhibitors; pemphigus; penicillamine