ABSTRACT
Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.
Subject(s)
Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , Skin Diseases/diagnosis , Skin Diseases/drug therapy , Dose-Response Relationship, Drug , Drug Administration Schedule , Eczema/drug therapy , Female , Graft vs Host Disease , Humans , Lichen Planus/drug therapy , Male , Mycophenolic Acid/adverse effects , Mycophenolic Acid/pharmacology , Pregnancy , Psoriasis/drug therapy , Pyoderma Gangrenosum/drug therapy , Randomized Controlled Trials as Topic , Risk Assessment , Skin Diseases, Vesiculobullous/drug therapy , Treatment OutcomeSubject(s)
Anti-Infective Agents, Local/therapeutic use , Antifungal Agents/therapeutic use , Dermatomycoses/diagnosis , Dermatomycoses/drug therapy , Foot Diseases/diagnosis , Foot Diseases/drug therapy , Nail Diseases/diagnosis , Nail Diseases/drug therapy , Contraindications , Dermatomycoses/physiopathology , Diagnosis, Differential , Female , Foot Diseases/physiopathology , Humans , Male , Nail Diseases/physiopathology , Treatment FailureABSTRACT
Cicatricial pemphigoid is a chronic vesiculobullous disease of the mucosal epithelium that primarily involves the oral cavity and the eyes. The clinical and histologic features are identical to those of bullous pemphigoid, and these features often can be nonspecific for other disease processes. It is not unusual for a period of 1 year or more to elapse before a diagnosis is made. The diagnosis of cicatricial pemphigoid requires characteristic lesions and histopathologic evidence of immunoglobulin deposition along the basement membrane, as well as a high index of suspicion. The authors detail a case of cicatricial pemphigoid resulting in airway obstruction and present the treatment required for both stabilization of the airway and resolution of the disease process.