Minocycline is a useful adjuvant therapy for pemphigus

Abstract

SUMMARY Pemphigus is an autoimmune blistering disease with high mortality if untreated. The cases of 10 patients who had minocycline 100 mg daily added as adjuvant therapy are reported. Prior to the use of minocycline, all patients had active disease, nine were on prednisolone (10–40 mg) and five were on azathioprine (100–200 mg). The response was assessed on clinical improvement and reduction of immunosuppressive (IS) drugs. It was graded into four categories: major, minor, equivocal and no significant response. A major response was seen in four patients, minor in two, equivocal in one and no improvement in three patients. The prednisolone dose in the six responders was reduced to 0–6 mg (0 mg in three patients), with an average decrease of 21 mg. The average time to respond was 8 months. Of the six responders, three were on azathioprine, which was ceased in two patients and reduced by two‐thirds in the other patient. No patient ceased minocycline because of side effects. In conclusion, minocycline 100 mg daily is a simple, safe and well tolerated treatment that should be tried in patients with pemphigus to reduce disease activity and/or the dose of potent IS agents.

Minocycline-Induced Hyperpigmentation in Patients With Pemphigus and Pemphigoid

“…[2][3][4] Our patients developed 2 types of minocycline-induced hyperpigmentation: the postinflammatory type at sites of previous lesions and the diffuse bluegray pigmentation in other skin areas (Table 3). With the exception of the series presented by Gaspar et al, 16 results of other studies of minocycline- †Other sites of pigmentation were the dorsum of the hands and forearms (patient 3) and the back (patient 7). ‡Patient also taking imipramine, which has been reported to cause hyperpigmentation; however, her lesions were clinically and histologically consistent with minocycline-induced hyperpigmentation.…”

“…Patients in the series by Gaspar et al 16 and Reiche et al 15 were receiving 100 mg of minocycline daily, and our patients and those in the series by Altman et al 14 were receiving 100 mg twice daily. Reports of pigmentation location in these series were confined to the pretibial areas.…”

“…18,19,[23][24][25][26] In PV and BP, most authors 16,18,19,[23][24][25][26] report efficacy at least equal to that of previous immunosuppressive therapies, and some suggest use of tetracyclines as a first-line agent in light of their favorable side effect profile. Although most studies focus on the efficacy and adverse effects of tetracycline therapy, minocycline has been used often as an initial agent 16 or as an alternative if tetracycline adverse effects develop. 14,15 Observations that our patients with immunobullous disease had a significantly higher incidence of minocycline-induced hyperpigmentation suggests that this phenomenon in PV and BP is more common than in acne vulgaris or rheumatoid arthritis.…”

Mechanisms of Mitochondrial Damage in Keratinocytes by Pemphigus Vulgaris Antibodies

“…Inhibits mitochondrial permeability transition pore by reducing mitochondrial Ca 2ϩ uptake, decreases release of mitochondrial pro-apoptotic, increases anti-apoptotic factors, and also modulates the activity of poly(ADPribose) polymerase (41) Used a steroid-sparing drug to treat PV patients alone or in combination with nicotinamide (34,(57)(58)(59)(60) …”

Pemphigus Vulgaris: Update on Etiopathogenesis, Oral Manifestations, and Management

“…Other agents used with variable benefit include gold (Penneys et al, 1976;Salomon and Saurat, 1986), dapsone (Piamphongsant, 1979;Basset et al, 1987), etretinate (Orfanos and Bauer, 1983), prostaglandin E 2 (Morita et al, 1995), and minocycline (Gaspar et al, 1996).…”