Precautions and Suggestions for Pemphigus Patients

Abstract

The onset and course of pemphigus are often the result of an interaction between predisposing genetic factors and environmental triggering agents. The latter are heterogeneous, numerous and increasing, ranging from drug intake (the commonest cause of pemphigus induction) to the exposure to physical agents (heat, UV and ionizing rays, surgical and cosmetic procedures), viral infections (especially by herpesvirus), contact dermatitis, certain diet ingredients and even emotional stress. Alerting physicians and pemphigus patients to the effects that unsuspected precipitating factors may have on the progression of the disease is an important task. In fact, avoiding or limiting deleterious habits (e.g. overindulging in unnecessary drugs) and suggesting alternative ways (e.g. substituting potentially pemphigus-inducing drugs with others considered harmless in this respect) may be a useful precaution in the management of pemphigus patients, since it can improve the efficacy of conventional treatments, reduce the risks of relapses and sometimes result in a cure.

Pemphigus Vulgaris after Coxsackievirus Infection and Cephalosporin Treatment: A Paraviral Eruption?

“…As a matter of fact, many coxsackievirus syndromes are associated with oral enanthemas or cutaneous rashes, such as vesicular stomatitis, morbilliform exanthema, widespread vesicular eruption and even Giannotti-Crosti-like eruption [6]. As to the drug administered to control possible bacterial complications, it belongs to the cephalosporins, a class of antibiotics with a well-known potential of inducing pemphigus because of their chemical structure of both a thiol group and a phenol ring [1, 7]. …”

Role of Corticosteroids in Oral Lesions

“…Corticosteroids can be prescribed in the form of a paste, an ointment or a mouthwash administered as monotherapy or as adjunctive therapy with a systemic treatment (Fellner;Ruocco 2001). …”

“…This treatment, which gives inconsistent results, involves sublesional injections given every 7 to 15 days; treatment is stopped after 3 injections if there is no improvement. Scarring is accompanied by cutaneous or mucosal atrophy the major drawback of this treatment (Fellner;Ruocco 2001). If the patient has extraoral lesions or if the oral damage is extensive, systemic corticosteroid therapy is initiated immediately.…”

Stressful Life Events and Pemphigus

“…Among the factors that induce pemphigus [1] in genetically predisposed patients, we find the following: ‘thiol drugs’ with an elevated risk for e.g. penicillamine, penicillin, cephalosporins or captopril; ‘angiotensin-converting enzyme inhibitors’ (elevated risk for enalapril and captopril); ‘phenol drugs’ (elevated risk for pyritinol and cephalosporins), and ‘miscellaneous substances’ with cytokines, pyrazolones and other nonsteroidal anti-inflammatory drugs.…”