Three weeks after completing a 4-pulse course of itraconazole for toenail onychomycosis, a 25-year-old woman patient developed severe liver crisis and required an emergency liver transplant. We report the case and discuss the use of itraconazole in onychomycosis and dermatomycoses.

Pemphigus is an autoimmune disease that results from the interaction between predisposing genetic factors and exogenous factors, the most common environmental factors being drugs and food. Topical phenol has induced pemphigus in one patient. Drugs and foods that induce pemphigus are divided into three main groups according to their chemical structure: thiols (containing a sulfhydryl group), phenol, nonthiol nonphenol. Thiol and phenol compounds can induce acantholysis in tissue cultures in vitro. The suggested mechanisms for thiol acantholysis include direct biochemical impairment of cell adhesion, protease activation and immunological reaction with the formation of a neoantigen. Possible mechanisms of phenol-induced pemphigus include the induction of IL-1alpha and TNF-alpha release by keratinocytes. These cytokines have been shown to be relevant in the regulation and synthesis of complement and proteases, like plasminogen activator, which has been implicated in the pathogenesis of acantholysis in pemphigus vulgaris. Avoiding exposure of genetically predisposed individuals to these factors is important in treating and preventing this disease.

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