A large number of drugs have been implicated in causing drug-induced pemphigus:
(1) some contain a thiol group
(2) some have metabolites with a thiol group
(3) some contain a pyrazol group
(4) some are antibiotics
(5) others (diverse group)
There may be a time interval between when a person was given the drug and the appearance of the skin lesions. Since some of these drugs are widely used the relationship can become tenuous.
Antibody used for immunostaining: to desmogleins 1 and 3 (monoclonal 32-2B)
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Pattern
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Features
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normal
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fine dots along the cytoplasmic membranes; a darker band is seen below the stratum corneum on low power
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patchy
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coarse granules along the cytoplasmic borders of keratinocytes; may be found in cells of adnexal structures (hair follicles and sweat glands)
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84% of patients with idiopathic pemphigus show a patchy pattern.
70% of patients with drug-induced pemphigus have a normal pattern. Most of these patients will recover if the implicated drug is discontinued.
30% of patients with drug-induced pemphigus have a patchy pattern. Most of these do not recover if the implicated drug is discontinued.
NOTE: There is a divergence between the data in Table 4 and the results given in column 1 on page 373 (in Table 4 there are 37 people with drug-induced pemphigus while in the text the numbers add up to 26).
