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Penicillamine-induced bullous dermatoses
1Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Journal of the American Academy of Dermatology
|November 1, 1996
Summary
D-penicillamine (DPA) can cause rare autoimmune bullous syndromes, often pemphigus-like, which may not improve even after stopping DPA. These reactions are typically late-onset and not dose-dependent.
Area of Science:
- Dermatology
- Rheumatology
- Immunology
Background:
- D-penicillamine (DPA) is a therapeutic agent with known adverse effects.
- Autoimmune bullous syndromes are uncommon but significant adverse reactions to DPA.
- These reactions often manifest late in treatment for immune-mediated diseases like rheumatoid arthritis.
Purpose of the Study:
- To review and characterize DPA-induced autoimmune bullous syndromes.
- To differentiate these drug-induced conditions from their spontaneous counterparts.
- To assess the prognosis and treatment implications of DPA-induced bullous diseases.
Main Methods:
- Literature review of reported cases of DPA-induced bullous conditions.
- Analysis of clinical presentation, immunofluorescence findings, and patient outcomes.
- Comparison of DPA-induced syndromes with spontaneously occurring autoimmune bullous diseases.
Main Results:
- The majority of DPA-induced bullous syndromes resemble pemphigus foliaceus or erythematosus.
- These drug-induced conditions often show fewer antibodies and abnormal immunofluorescence patterns compared to spontaneous pemphigus.
- DPA-induced cicatricial pemphigoid is severe, affecting both skin and mucous membranes, with a prognosis similar to spontaneous disease.
Conclusions:
- D-penicillamine can trigger various autoimmune bullous syndromes, predominantly pemphigus-like.
- Some DPA-induced bullous diseases may persist despite drug withdrawal, indicating a complex pathogenesis.
- Accurate diagnosis and differentiation from spontaneous conditions are crucial for appropriate management.