Systemic minocycline as a therapeutic option in predominantly oral mucous membrane pemphigoid: a cautionary report

Carrozzo, Marco; Arduino, Paolo Giacomo; Bertolusso, Giorgio; Cozzani, Emanuele; Parodi, Aurora

doi:10.1016/j.ijom.2009.06.021

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…Five studies (Nayar and Wojnarowska, ; Poskitt and Wojnarowska, ; Reiche et al , ; Carrozzo et al , ; Chaidemenos et al , ) commented on cycline family of drugs (mainly minocycline) with and without nicotinamide, the results of which are controversial with a discontinuation rate up to 67%.…”

Section: Resultsmentioning

confidence: 99%

“…Some medications such as tetracycline or sulfa drugs that were deemed promising (Kirtschig et al , ) are now under serious scrutiny for their safety profile (Wertheim et al , ; Hegarty et al , ; Carrozzo et al , ). Cycline group of medications can rarely cause clinical remission, have little effect on ocular disease, and can cause serious and frequent adverse effects, particularly minocycline (Carrozzo et al , 2010).…”

Section: What Is the Best Therapeutic Option For Mmp?mentioning

confidence: 99%

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Urban legend series: mucous membrane pemphigoid

Zenzo

Carrozzo

Chan³

2013

Oral Diseases

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Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune subepithelial blistering diseases affecting primarily mucous membranes showing marked degree of clinical and immunological variability. We investigated four controversial topics: (i) Does oral pemphigoid (OP) really exist as a separate entity? (ii) Is mucous membrane pemphigoid curable? (iii) What is the best therapeutic option for MMP? (iv) Does exclusive oral IgA dermatitis exist as a distinct entity from MMP? Results from extensive literature searches suggested that (i) it is still unclear whether patients with OP could be considered as a distinct subset of MMP with specific clinical and immunological features; (ii) it is uncertain whether treatment regimens that get MMP under control can be eliminated to allow patients to be in drug-free remission or they should be continuously administered in some capacities; (iii) there is a concerning paucity of good-quality trials on MMP and available recommendations are solely based on generally small patients' cohorts or case series. Some of the 2002 consensus experts' opinions should be possibly updated, particularly regarding the safety of sulfa drugs; (iv) we did not find any strong evidence to support an exclusive oral (and perhaps also mucosal) form of LAD as a separate entity.

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Section: Resultsmentioning

confidence: 99%

Section: What Is the Best Therapeutic Option For Mmp?mentioning

confidence: 99%

Urban legend series: mucous membrane pemphigoid

Zenzo

Carrozzo

Chan³

2013

Oral Diseases

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“…Most patients included in the studies taken into consideration have been switched to tetracyclines due to adverse effects with previous treatments. On the other hand, minocycline has been stopped in five out of nine patients included in a case series of predominantly oral MMP due to its side effects, mainly vertigo and gastric upset 149 . In this case series with a follow‐up of 2 years, only one patient achieved persistent remission with no relapse.…”

Section: Managementmentioning

confidence: 97%

European Guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part II

Schmidt

Rashid

Marzano

et al. 2021

Acad Dermatol Venereol

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113

109

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This guideline has been initiated by the task force Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology, including physicians from all relevant disciplines and patient organizations. It is a S3 consensus‐based guideline that systematically reviewed the literature on mucous membrane pemphigoid (MMP) in the MEDLINE and EMBASE databases until June 2019, with no limitations on language. While the first part of this guideline addressed methodology, as well as epidemiology, terminology, aetiology, clinical presentation and outcome measures in MMP, the second part presents the diagnostics and management of MMP. MMP should be suspected in cases with predominant mucosal lesions. Direct immunofluorescence microscopy to detect tissue‐bound IgG, IgA and/or complement C3, combined with serological testing for circulating autoantibodies are recommended. In most patients, serum autoantibodies are present only in low levels and in variable proportions, depending on the clinical sites involved. Circulating autoantibodies are determined by indirect IF assays using tissue substrates, or ELISA using different recombinant forms of the target antigens or immunoblotting using different substrates. The major target antigen in MMP is type XVII collagen (BP180), although in 10–25% of patients laminin 332 is recognized. In 25–30% of MMP patients with anti‐laminin 332 reactivity, malignancies have been associated. As first‐line treatment of mild/moderate MMP, dapsone, methotrexate or tetracyclines and/or topical corticosteroids are recommended. For severe MMP, dapsone and oral or intravenous cyclophosphamide and/or oral corticosteroids are recommended as first‐line regimens. Additional recommendations are given, tailored to treatment of single‐site MMP such as oral, ocular, laryngeal, oesophageal and genital MMP, as well as the diagnosis of ocular MMP. Treatment recommendations are limited by the complete lack of high‐quality randomized controlled trials.

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“…A tetracycline type antibiotic, minocycline, alone or in combined with nicotinamide has also been reported in the treatment of MMP [23,24] . Although it has effective anti-inflammatory and immunesuppressive properties and shown as a safe alternative for MMP patients; several side effects including vertigo and gastralgia may cause withdrawal of the drug [6,25] .…”

mentioning

confidence: 99%

“…Recently Carrozzo et al [25] evaluated the therapeutic benefit of minocycline in patients with oral MMP. They reported a major response in 3 patients, a minor response in 4 and no response in 2 patients but also one patient showed permanent remission.…”

mentioning

confidence: 99%

Localized Oral Mucous Membrane Pemphigoid: Successful Treatment with Intralesional Triamcinolone Acetonide Injection

Erbaşar¹

2016

JDOC

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Mucous membrane pemphigoid (MMP) is a rare, chronic and vesiculobullous disorder that classified as autoimmune disease.MMP can affect various mucous membranes but predominantly occurs in the oral cavity. In most of cases oral lesions may be initial manifestation or the only sign of the disease. It is predominantly seen in the fifth decade of life. It affects women more commonly than men. Children are rarely affected from this disease. MMP may cause extremely variable severity due to different clinical presentations as vesicles, erosions, pain, and occasional scarring. Oral lesions as gingival inflammation and scarring are not life theatening but lead to functional limitations. The primary goals of the treatment are to cease the progression of the disease, reduce the symptoms, and prevent the sequelae of tissue ulseration and consecutive scarring. The mild MMP lesions may be successfully managed with topical corticosteroids. However, the lesions that do not respond to local treatments or become widespread and also the diseases which show rapid progress can be treated can be treated with systemic glucocorticoids and immunosuppressive agents such as azathioprine, mycophenolatemofetyl, cyclosporine, and dapsone, rituximab and intravenous immunoglobulin. In this report two cases of oral MMP treated successfully with intralesional triamcinolone acetonide are presented along with a review of literature.

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Systemic minocycline as a therapeutic option in predominantly oral mucous membrane pemphigoid: a cautionary report

Cited by 13 publications

References 21 publications

Urban legend series: mucous membrane pemphigoid

Urban legend series: mucous membrane pemphigoid

European Guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part II

Localized Oral Mucous Membrane Pemphigoid: Successful Treatment with Intralesional Triamcinolone Acetonide Injection

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