Use of topical cyclosporin in oral pemphigus

A novel explanation for acantholysis in pemphigus vulgaris: The basal cell shrinkage hypothesis

“…The involvement of these pathways in the pathogenesis of acantholysis may explain why the current immunosuppressive agents used to treat pemphigus, all of which have complex effects on cellular functions, 40 can improve the disease while high circulating levels of pemphigus antibodies are still present, 41,42 and why topical therapy that has no effect on antibody levels can be effective. [43][44][45] CONCLUSIONS The hypothesis we propose and the ones currently accepted are not mutually exclusive. It may be that each contributes partially to the final pathology of PV.…”

Mechanisms of Mitochondrial Damage in Keratinocytes by Pemphigus Vulgaris Antibodies

“…Cyclosporine A Inhibits mitochondrial permeability transition pore by preventing the binding of cyclophilin D to pore proteins (42,43) Used to treat PV patients as an immunosuppressor drug both systemically and topically; has been effective as a monotherapy in a few PV patients, but most commonly used as a steroid-sparing drug, inducing a prolong remission (29)(30)(31)(44)(45)(46)(47); partially inhibited signs of experimental PV in mice (48) Nicotinamide, also called niacinamide, an amide of nicotinic acid; one of two principal forms of the B-complex vitamin, B 3 Nicotinamide is a precursor of the coenzyme NAD …”

Calcineurin inhibitors in oral medicine

“…There are small numbers of reports of topical cyclosporine being effective for the oral lesions of pemphigus vulgaris. 64,83 Topical cyclosporine (5 mL of oral suspension [500 mg] 3 times/d) was reported to be effective in the treatment of a cohort of 12 patients with oral pemphigus recalcitrant to conventional treatment. After 2 months, a significant improvement in both symptoms and signs was reported.…”