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May 21, 1982, Vol 247, No. 19 >
ARTICLE | May 21, 1982

Penicillamine-Induced Pemphigus FREE

John Zone, MD; John Ward, MD; Eric Boyce, RPT; Curtis Schupbach, MD
[+] Author Affiliations

Reprint requests to 50 N Medical Dr, Salt Lake City, UT 84132 (Dr Zone).


JAMA. 1982;247(19):2705-2707. doi:10.1001/jama.1982.03320440053036
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References

Penicillamine therapy has been associated with a variety of autoimmune disorders, including pemphigus vulgaris and pemphigus foliaceus. The "late scaling rash" or oral ulcerations associated with penicillamine may represent the superficial erosions of early pemphigus. We describe four patients with pemphigus induced by penicillamine therapy and emphasize the "seborrhea-like" characteristics of this eruption that may obscure the diagnosis. A high prevalence (71%) of HLA-B15 is noted in the seven patients on whom HLA data are available. Early recognition is important because of the potentially fatal nature of pemphigus. The mechanism by which penicillamine induces or unmasks pemphigus and other immunologic syndromes remains to be elucidated.

(JAMA 1982;247:2705-2707)

REFERENCES

1 +
Multicenter Trial Group:  Controlled trial of D(—) penicillamine in severe rheumatoid arthritis . Lancet 1973;;1:275-280.
2 +
Halverson PB, Kozin F, Bernhard GB, et al:  Toxicity of penicillamine . JAMA 1978;;240:1870-1871.
3 +
Atcheson SG, Ward JR:  Ptosis and weakness after start of D-penicillamine therapy . Ann Intern Med 1978;;89:939-940.
4 +
Sternlieb I:  Penicillamine and nephrotic syndrome: Results in patients with hepatolenticular degeneration . JAMA 1966;;198:1311-1312.
5 +
Cucher BG, Goldman AL:  Penicillamine induced polymyositis in rheumatoid arthritis . Ann Intern Med 1978;;85:615-616.
6 +
Harkim TM, Conn DC, Holley KE:  D-Penicillamine and lupus erythematosus-like syndrome . Ann Intern Med 1978;;89:1012.
7 +
Sternlieb I, Bennett B, Scheinber IH:  D-Penicillamine induced Goodpasture's syndrome in Wilson's disease . Ann Intern Med 1975;;82:673-676.
8 +
Cruz DJ, Marcus MD, Prioleau PG, et al:  Pemphigus-like lesions induced by D-penicillamine . Am J Dermatopathol 1981;;3:85-92.
9 +
Greer KE, Askew FC, Richardson DR:  Skin lesions induced by D-penicillamine . Arch Dermatol 1976;;112:1267-1269.
10 +
DeJong MCMJ, Doeglas HMG, Dijkstra JWE:  Immunohistochemical findings in a patient with penicillamine pemphigus . Br J Dermatol 1980;;102:333-337.
11 +
Marsden RA, Ryan TJ, VanHegan RI, et al:  Pemphigus foliaceus induced by penicillamine . Br Med J 1976;;2:1423-1424.
12 +
Katz SI, Dahl MV, Penneys N, et al:  HL-A antigens in pemphigus . Arch Dermatol 1973;; 108:53-55.
13 +
Hashimoto K, Yoshiharu M, Nakata S, et al:  HLA-A10 in pemphigus among Japanese . Arch Dermatol 1977;;113:1518-1519.
14 +
From E, Frederickson P:  Pemphigus vulgaris following D-penicillamine . Dermatologica 1976;;152:358-362.
15 +
Thorvaldsen J:  Two cases of penicillamineinduced pemphigus erythematosus . Dermatologica 1979;;159:167-170.
16 +
Tan SG, Rowell NR:  Pemphigus-like syndrome induced by D-penicillamine . Br J Dermatol 1976;;95:99-100.
17 +
Cairns RJ:  Penicillamine-induced pemphigus . Proc R Soc Med 1976;;69:384.
18 +
Sparrow JP:  Penicillamine pemphigus and the nephrotic syndrome occurring simultaneously . Br J Dermatol 1978;;98:103-105.
19 +
Marsden RA, Dawber RPR, Millard PR, et al:  Herpetiform pemphigus induced by penicillamine . Br J Dermatol 1977;;97:451-452.
20 +
Dische FE, Swinson DR, Hamilton EBD, et al:  Immunopathology of penicillamine induced glomerular disease . J Rheumatol 1976;;3:145-154.
21 +
Pegum JS, Pembroke AC:  Benign mucous membrane pemphigoid associated with penicillamine treatment . Br Med J 1977;;1:1473.

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1 +
Multicenter Trial Group:  Controlled trial of D(—) penicillamine in severe rheumatoid arthritis . Lancet 1973;;1:275-280.
2 +
Halverson PB, Kozin F, Bernhard GB, et al:  Toxicity of penicillamine . JAMA 1978;;240:1870-1871.
3 +
Atcheson SG, Ward JR:  Ptosis and weakness after start of D-penicillamine therapy . Ann Intern Med 1978;;89:939-940.
4 +
Sternlieb I:  Penicillamine and nephrotic syndrome: Results in patients with hepatolenticular degeneration . JAMA 1966;;198:1311-1312.
5 +
Cucher BG, Goldman AL:  Penicillamine induced polymyositis in rheumatoid arthritis . Ann Intern Med 1978;;85:615-616.
6 +
Harkim TM, Conn DC, Holley KE:  D-Penicillamine and lupus erythematosus-like syndrome . Ann Intern Med 1978;;89:1012.
7 +
Sternlieb I, Bennett B, Scheinber IH:  D-Penicillamine induced Goodpasture's syndrome in Wilson's disease . Ann Intern Med 1975;;82:673-676.
8 +
Cruz DJ, Marcus MD, Prioleau PG, et al:  Pemphigus-like lesions induced by D-penicillamine . Am J Dermatopathol 1981;;3:85-92.
9 +
Greer KE, Askew FC, Richardson DR:  Skin lesions induced by D-penicillamine . Arch Dermatol 1976;;112:1267-1269.
10 +
DeJong MCMJ, Doeglas HMG, Dijkstra JWE:  Immunohistochemical findings in a patient with penicillamine pemphigus . Br J Dermatol 1980;;102:333-337.
11 +
Marsden RA, Ryan TJ, VanHegan RI, et al:  Pemphigus foliaceus induced by penicillamine . Br Med J 1976;;2:1423-1424.
12 +
Katz SI, Dahl MV, Penneys N, et al:  HL-A antigens in pemphigus . Arch Dermatol 1973;; 108:53-55.
13 +
Hashimoto K, Yoshiharu M, Nakata S, et al:  HLA-A10 in pemphigus among Japanese . Arch Dermatol 1977;;113:1518-1519.
14 +
From E, Frederickson P:  Pemphigus vulgaris following D-penicillamine . Dermatologica 1976;;152:358-362.
15 +
Thorvaldsen J:  Two cases of penicillamineinduced pemphigus erythematosus . Dermatologica 1979;;159:167-170.
16 +
Tan SG, Rowell NR:  Pemphigus-like syndrome induced by D-penicillamine . Br J Dermatol 1976;;95:99-100.
17 +
Cairns RJ:  Penicillamine-induced pemphigus . Proc R Soc Med 1976;;69:384.
18 +
Sparrow JP:  Penicillamine pemphigus and the nephrotic syndrome occurring simultaneously . Br J Dermatol 1978;;98:103-105.
19 +
Marsden RA, Dawber RPR, Millard PR, et al:  Herpetiform pemphigus induced by penicillamine . Br J Dermatol 1977;;97:451-452.
20 +
Dische FE, Swinson DR, Hamilton EBD, et al:  Immunopathology of penicillamine induced glomerular disease . J Rheumatol 1976;;3:145-154.
21 +
Pegum JS, Pembroke AC:  Benign mucous membrane pemphigoid associated with penicillamine treatment . Br Med J 1977;;1:1473.

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