Successful treatment with doxycycline and nicotinamide of two cases of persistent pemphigoid gestationis

Abstract

Pemphigoid gestationis (PG) is a rare dermal-epidermal autoimmune bullous disease of pregnancy and postpartum, which relapses more seriously and earlier during following pregnancies. PG also occurs in association with trophoblastic tumours or oral contraceptive treatment. The term 'persistent PG' represents the cases where active disease persists for months to many years after delivery. Four cases of persistent PG have been reported to date in the literature. So far, systemic cortico-steroids have been the main PG therapy and the use of cyclophosphamide, dapsone, pyridoxine, methotrexate, plasmapheresis or ritodrine has also been reported, with contradictory results. In this paper are described two patients with persistent PG who were successfully treated with doxycycline (200 mg/day) and nicotinamide (500 mg/day), a treatment that was demonstrated to be safe and efficacious in bullous pemphigoid.

Antibiotics used in nonbacterial dermatologic conditions

“…Other investigators argue that treatment with tetracycline and nicotinamide requires further validation (75). Several mechanisms have been proposed to explain the potential for tetracycline/nicotinamide as effective treatment in bullous pemphigoid (77). Nicotinamide acts as an inhibitor of phosphodiesterase and also directly inhibits histamine release at the histamine receptor.…”

“…At the time these cases were published, patients continued to be clear (as of 10 and 6 months, respectively). As discussed under "Bullous Pemphigoid," several proposed mechanisms may explain the potential for tetracycline/ nicotinamide as effective treatment (77).…”

Treatment of linear IgA bullous dermatosis of childhood with flucloxacillin

“…Tetracyclines have been established as a good alternative for treatment of bullous pemphigoid. [16][17][18][19] In the first patient of this series, we gave flucloxacillin instead of dapsone after discovering the low serum levels of G6PD. After this successful trial, we extended our experience in the following cases in spite of normal G6PD levels.…”

“…[13][14][15] Other immunobullous diseases including bullous pemphigoid and linear IgA bullous dermatosis of adulthood have responded to different antibiotics including tetracyclines and erythromycin. [16][17][18][19][20][21][22][23] Herein we describe 7 cases of linear IgA bullous dermatosis of childhood treated effectively with flucloxacillin, causing rapid and lasting remission in 4 cases and excellent control in the remaining ones.…”

Specific dermatoses of pregnancy: advances and controversies

“…Alternative treatments need to be considered in postpartum recalcitrant or chronic HG because of the serious adverse effects of long-term steroid therapy. Minocycline or doxycycline, in combination with nicotinamide, have been successfully used in nonbreastfeeding mothers with refractory HG [98,99]. High-dose intravenously administered IgG in combination with cyclosporine or other immunosuppressant medications has shown some success [75,100].…”