From the Guidelines
Calcium channel blockers and ACE inhibitors can be considered causes of drug-induced pemphigus, although they are not specifically listed as common triggers in the provided guidelines. According to the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1, drugs can trigger pemphigus, but this is uncommon, and there are no clinical or laboratory tests that can distinguish drug-induced cases from idiopathic pemphigus reliably. The guidelines mention three groups of chemical structures that have been suggested to cause drug-induced pemphigus: thiol drugs, phenol drugs, and nonthiol, nonphenol drugs.
Some key points to consider in the management of drug-induced pemphigus include:
- A thorough drug history is essential to identify potential triggers
- A poor response to standard systemic treatments should alert to the possibility of drug-induced pemphigus
- Initial management includes stopping the offending drug, possibly combined with conventional treatment in severe cases
- The disease may continue in 50% of cases despite drug withdrawal, while others recover completely
In terms of specific medications, the guidelines do not mention calcium channel blockers or ACE inhibitors as common triggers for drug-induced pemphigus. However, other sources suggest that certain calcium channel blockers, such as nifedipine, diltiazem, and verapamil, and ACE inhibitors, such as captopril, enalapril, and lisinopril, have been implicated in triggering this condition. If a patient develops unexplained blistering while taking these medications, the drug should be suspected as a potential cause, and discontinuation of the triggering medication should be considered. Alternative antihypertensive medications from different classes should be considered for patients who develop this reaction.
From the FDA Drug Label
Dermatologic : Bullous pemphigus, erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis. ACE inhibitors, such as captopril, can be considered one of the drug-induced pemphigus causes, as bullous pemphigus is listed as a reported adverse effect in the drug label 2 and 2.
- Key points:
- Bullous pemphigus is a reported adverse effect of captopril.
- ACE inhibitors can cause drug-induced pemphigus.
- The drug label explicitly mentions bullous pemphigus as a possible adverse effect.
From the Research
Drug-Induced Pemphigus
- Calcium channel blockers and ACE inhibitors can be considered as potential causes of drug-induced pemphigus, although the evidence is limited.
- A study published in 2019 3 reported a case series of three patients who developed pemphigus after taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.
- However, there is no direct evidence in the provided studies that specifically links calcium channel blockers to drug-induced pemphigus.
- The studies primarily focus on the treatment of pemphigus vulgaris and other forms of pemphigus, with discussions on corticosteroids, immunosuppressive agents, and other therapies 4, 5, 6.
- A study published in 2022 7 compared the effects of calcium channel blockers with other antihypertensive drug classes, but it did not address the topic of drug-induced pemphigus.
Treatment of Pemphigus
- The treatment of pemphigus typically involves the use of corticosteroids and immunosuppressive agents, such as azathioprine and mycophenolate mofetil 4, 5, 6.
- Rituximab, a monoclonal antibody, is also approved as a first-line therapy for moderate-to-severe pemphigus 6.
- The management of pemphigus requires a multidisciplinary approach, and the treatment should be tailored to the individual patient's needs 5.