Penicillamine-induced bullous dermatoses

J Am Acad Dermatol. 1996 Nov;35(5 Pt 1):732-42. doi: 10.1016/s0190-9622(96)90729-x.

Abstract

The successful therapeutic use of D-penicillamine (DPA) has been hindered by its many adverse effects. Autoimmune bullous syndromes are among the less common adverse DPA reactions; they are not dose dependent and appear late in the treatment of diseases of altered immunity, most often rheumatoid arthritis. The majority of the DPA-induced bullous syndromes belong to the pemphigus spectrum, usually pemphigus foliaceus or erythematosus, have a lower prevalence of demonstrable tissue-fixed or circulating antibodies than spontaneously occurring pemphigus, display abnormal direct immunofluorescent patterns, and have a generally favorable prognosis. However, many cases do exhibit a full-blown chronic disease, unaffected by DPA withdrawal. DPA-induced cicatricial pemphigoid is a severe disease of both mucous and cutaneous involvement with a prognosis similar to the spontaneous disease. Cases of DPA-induced epidermolysis bullosa acquisita and DPA-induced bullous pemphigoid were not sufficiently substantiated by immunofluorescence or immunoprecipitation criteria.

Publication types

  • Review

MeSH terms

  • Drug Eruptions / etiology*
  • Humans
  • Penicillamine / adverse effects*
  • Penicillamine / chemistry
  • Penicillamine / metabolism
  • Skin Diseases, Vesiculobullous / chemically induced*
  • Skin Diseases, Vesiculobullous / diagnosis

Substances

  • Penicillamine