Contact pemphigus

Pemphigus Vegetans Associated with Intranasal Cocaine Abuse

Background:

Pemphigus vegetans is a rare variant of pemphigus vulgaris, comprising 1 to 2% of all pemphigus cases. Exposures to oral agents such as captopril and penicillamine and, less commonly, physical or chemical factors have been implicated in the development of pemphigus.

Methods:

We report a 42-year-old white male with a 12-month history of hypertrophic, vegetative plaques affecting primarily his external nares and upper lips. The patient had a history of alcoholism and intermittent drug abuse, primarily intranasal cocaine, since his youth. He had been using cocaine heavily three to four times/week for 1 month prior to and 1 month following the onset of the eruption but has since ceased use. His clinical features and histopathologic findings were consistent with a diagnosis of pemphigus vegetans. Treatment with high-dose prednisone (80 mg/d) and mycophenolate mofetil (1.5 g/d) resulted in resolution of the lesions after 18 months.

Results and Conclusions:

To our knowledge, this is the second report proposing an association between intranasal cocaine use and the pemphigus family of disorders. Although the relationship between illicit drug use and the development of pemphigus is unclear, we postulate that intranasal cocaine abuse is operative in our patient's disease. Herein we discuss drug and other external precipitants of pemphigus and review previous case reports of pemphigus associated with illicit drugs.

Renseignements de base:

Le pemphigus végétant est une variante rare du pemphigus vulgaire, comptant pour 1 à 2 % de tous les cas de pemphigus. Un rapprochement a été établi entre l'exposition à des agents oraux tels que le captopril et la pénicillamine et, moins couramment, à des facteurs physiques ou chimiques, dans le développement du pemphigus.

Méthodes:

Nous exposons le cas d'un homme de race blanche âgé de 42 ans ayant des antécédents de plaques végétatives hypertrophiques pendant 12 mois, touchant principalement ses narines externes et ses lèvres supérieures. Le patient avait des antécédents d'alcoolisme et de consommation intermittente de drogues, principalement de la cocaïne prise par voie intranasale, depuis sa jeunesse. Il avait consommé de façon excessive de la cocaïne trois à quatre fois par semaine pendant le mois qui avait précédé et avait suivi l'apparition de l'éruption, mais il a depuis ce temps cessé d'en user. Ses caractéristiques cliniques et les résultats histopathologiques correspondaient à un diagnostic de pemphigus végétant. Le traitement consistant en la prise de fortes doses de prednisone (80 mg/j) et de mycophenolate mofetil (1,5 g/j) a entraîné la résorption des lésions après 18 mois.

Résultats et conclusions:

À notre connaissance, ce rapport est le deuxième qui propose l'existence d'une association entre la consommation de cocaïne par voie intranasale et le groupe de maladies pemphigus. Bien que la relation entre la consommation de drogues illicites et le développement du pemphigus ne soit pas claire, nous postulons que la consommation de cocaïne par voie intranasale a une incidence sur la maladie de notre patient. Nous discutons aux présentes des drogues et d'autres déclencheurs externes du pemphigus et nous examinons les rapports de cas antérieurs de pemphigus associé à la consommation de drogues illicites.

Suspected polymyxin B-induced pemphigus vulgaris in a dog

A case of pemphigus vulgaris (PV), putatively induced by topical application of polymyxin B ear drops, is described. A 3-year-old, female Tosa Inu, presented with acute onset swelling, blistering and ulceration of the pinnae, nostrils, lips and oral mucous membranes. The dog was depressed, febrile and anorexic. For 7 days prior to the onset of the acute ulcerative disease, polymyxin B ear drops had been applied to both ears to treat an ear infection. Skin and mucosal biopsies showed suprabasilar cleft formation and acantholysis, indicative of PV. The polymyxin B ear drops were discontinued and the dog was treated with intravenous fluids, systemic and topical antibacterial therapy, and immunosuppressive therapy comprising prednisone and azathioprine. Complete remission was noted after 2 weeks, and the immunosuppressive therapy was discontinued one month later. No clinical signs of PV recurred over a 1 year follow-up period. As PV does not usually resolve spontaneously, or enter long-term remission, it was considered that the condition was most likely drug induced due to the aural application of polymyxin B.

Pemphigus foliaceus with epidermal detachment: adverse events from patch testing

Uncommon adverse reactions to patch testing have been reported, but few cases have shown patch testing to be a potential contraindication. We report a patient with known pemphigus foliaceus who had significant epidermal detachment of normal skin during the removal of patch-testing tape.

Pénfigo

Pemphigus is an infrequent, organ-specific, autoimmune bullous disease, which affects the skin, mucous membranes and appendages. Histopathologically, it is characterized by acantholysis. Pemphigus has classically been divided into two major groups, pemphigus vulgaris and pemphigus foliaceus, with their respective clinical variants pemphigus vegetans and pemphigus erythematosus. In recent years, new variants of pemphigus have been described: paraneoplastic pemphigus, IgA pemphigus and pemphigus herpetiformis. This article reviews the epidemiology, etiopathogenesis, clinical symptoms, diagnosis, treatment and prognosis of pemphigus. Advances in molecular biology techniques have made it possible to more precisely identify the different antigens against which antibodies are directed, and to fine-tune ELISA diagnostic techniques. Treating pemphigus vulgaris and foliaceus with general steroids has modified their prognosis; it is estimated that mortality in recent decades is less than 10 %. Managing the clinical complications that appear during the evolution of the pemphigus has contributed to reducing morbidity and mortality.