Drug-Induced Pemphigus

Aka: Drug-Induced Pemphigus, Drug-Triggered Pemphigus

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II. Mechanism of Drug-Induced Pemphigus

  1. Sulfhydryl groups lyse disulfide bonds
  2. Results in Blister formation

III. Causes of Drug-Induced Pemphigus

  1. D-Penicillamine (5% Incidence with Penicillamine)
  2. Captopril

IV. Signs of Drug-Induced Pemphigus

  1. Pemphigus follows medication use of >2 month duration
  2. Similar to Superficial Pemphigus (Pemphigus Foliaceus)
    1. Most cases are mild

V. Differential Diagnosis of Drug-Induced Pemphigus

  1. Erythema Multiforme
  2. Drug-Triggered Pemphigus (unmasks Pemphigus Vulgaris)
    1. Rifampin
    2. Penicillin
    3. Cephalexin
    4. Progesterone
    5. Gold
    6. Piroxicam
    7. Phenobarbital

VI. Course

  1. Drug-Induced Pemphigus
    1. Remits with stopping medication in 40-50% of cases
    2. May follow severe course in some cases
  2. Drug-Triggered Pemphigus
    1. Does not remit
    2. Follows course of Pemphigus Vulgaris

VII. References

  1. Habif (1996) Clinical Dermatology, Mosby, p. 512
  2. Cotell (2000) Am J Emerg Med 18(3):288-99 [PubMed]
  3. Rye (1997) Am Fam Physician 55(8):2709-18 [PubMed]

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