Successful monotherapy of pemphigus vegetans with minocycline and nicotinamide.

BACKGROUND: Pemphigus vegetans is a rare variant of pemphigus vulgaris, accounting for 1-2% of all pemphigus diseases. Systemic corticosteroids are the therapy of first choice in combination with immunosuppressants as steroid-sparing agents. OBJECTIVE: To highlight the exceptional but successful use of minocycline/nicotinamide monotherapy in pemphigus vegetans. METHODS: A review of the literature to date about pemphigus vegetans with special emphasis on therapy was performed. Due to its rarity, multiple anecdotal reports without long-term follow-up are available and prospective controlled trials are lacking. Only one retrospective study from Tunisia includes 17 patients with pemphigus vegetans. RESULTS: We present a 76-year-old woman with pemphigus vegetans achieving complete response to a minocycline/nicotinamide monotherapy at onset and at relapse of the disease. Treatment has been discontinued after repeated direct immunofluorescence (DIF) of previously affected normal skin and anti-desmoglein 3 antibodies had become negative. In addition, DIF of previously involved oral mucosa was negative. During long-term follow-up clinical remission has been maintained for more than 5 years. Up to now, negative results of serial performed indirect immunofluorescence and desmoglein ELISA testing also predict immunological remission. CONCLUSION: In our patient and in a case with oesophageal involvement, published more than 20 years ago, clearly the benefit of minocycline/nicotinamide monotherapy was demonstrated. We propose to consider minocycline/nicotinamide as first-line monotherapy in pemphigus vegetans, especially in elderly patients with comorbidities and contraindications to standard therapy, as it avoids the toxicities of systemic corticosteroids and immunosuppressants.

Oxidation of citronellal to citronellic acid by molecular oxygen using supported gold catalysts.

The oxidation of citronellal to citronellic acid was studied using molecular oxygen as oxidant and gold-containing supported catalysts under aqueous conditions. The reactions were carried out at 60-90 degrees C, with 200 Nml min(-1) O2 and at pH values from 9 to 12. The alumina- or titania-supported catalysts were synthesized according to the deposition-precipitation procedure using urea or NaOH. Mechanistic studies have revealed that radical-initiated reactions lead to undesired by-products especially at pH <9, that is, the C=C bond is attacked and a diol is primarily formed probably via an epoxide intermediate. This side reaction can be suppressed to a large extent by increasing the pH to 12 and by raising the catalyst/oxygen ratio. Furthermore, detailed studies on the influence of reaction time, pH value, reactant concentration and amount of catalyst show that citronellic acid can be obtained in over 90% yield with total conversion of citronellal at pH 12 and a temperature of 80 degrees C.