Combination therapy with nicotinamide and tetracyclines for cicatricial pemphigoid: further support for its efficacy

Abstract

We have previously reported the reduction of cicatricial pemphigoid orodynia with minocycline. Tetracycline combined with high dose nicotinamide has also been beneficial in a number of cutaneous immunological disorders. We now report a series of eight cases in whom further subjective or clinical improvement accrued in five, after the addition of high dose (2.5 or 3 g) nicotinamide to minocycline; however, one of these then discontinued the nicotinamide because of headache and nausea, another was withdrawn from the study because of progressive upper respiratory tract mucosal involvement, and two were changed from minocycline to tetracycline because they developed minocycline-induced hyperpigmentation.

Minocycline-Induced Hyperpigmentation in Patients With Pemphigus and Pemphigoid

“…Patients in the series by Gaspar et al 16 and Reiche et al 15 were receiving 100 mg of minocycline daily, and our patients and those in the series by Altman et al 14 were receiving 100 mg twice daily. Reports of pigmentation location in these series were confined to the pretibial areas.…”

“…Although most studies focus on the efficacy and adverse effects of tetracycline therapy, minocycline has been used often as an initial agent 16 or as an alternative if tetracycline adverse effects develop. 14,15 Observations that our patients with immunobullous disease had a significantly higher incidence of minocycline-induced hyperpigmentation suggests that this phenomenon in PV and BP is more common than in acne vulgaris or rheumatoid arthritis. There have been several long-term studies 4,8,12 regarding hyperpigmentation in patients with acne vulgaris treated with minocycline.…”

Safety of high-dose nicotinamide: a review

“…Beneficial effects have been described in over 60 case reports where nicotinamide has also been used in the treatment of polymorphous light eruptions, necrobiosis lipoidica and pemphigoid [9,12,56,57]. Doses ranged from 1.5±3 g/day given for durations of 2 weeks to 6 months with few adverse effects.…”

Interventions for Mucous Membrane Pemphigoid/Cicatricial Pemphigoid and Epidermolysis Bullosa Acquisita

“…Fourteen studies investigated patients with oral and generalized MMP, 7,[17][18][19][21][22][23][24][25][26][27][28][29][30] 7 of which comment on sulfa drugs (dapsone, sulfapyridine, and sulfamethoxypyridazine); 68 of 106 patients benefited from this medication. [17][18][19]22,23,29 Of the 14 studies, 3 discuss the use of oral vs topical steroids in oral MMP, the results of which are controversial.…”

“…[26][27][28] Minocycline treatment is reported in 25 patients with generalized MMP. 7,29,30 This medication seems beneficial in oral MMP (orodynia), although little effect is seen in ocular disease. Sixteen articles present patients with mainly ocu- 37 found sulfapyridine to be superior to dapsone.…”