title: "Two-step" pemphigus induction by ACE-inhibitors.
abstract: Pemphigus lesions appeared in a 58-year-old man who was taking captopril for his hypertension. Drug withdrawal resulted in complete remission of the eruption. The subsequent use of enalapril as an antihypertensive agent caused a recurrence of pemphigus lesions along with onset of itching and dermographism. Intercellular antibodies were not found. Discontinuance of enalapril therapy had no effect on the clinical course. Steroid treatment was needed to resolve the eruption. Recently repeated immunofluorescent studies disclosed intercellular IgG antibodies in the serum at a low titer. Pemphigus induction could be initially related to the thiol acantholytic property of captopril. Subsequent production of intercellular antibodies and drug-activation of the kinin system could be responsible for relapsing.
authors.affiliation: Department of Dermatology, First School of Medicine, University of Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ruocco
authors.forename: R A
authors.initials: RA
authors.lastname: Satriano
authors.forename: V
authors.initials: V
authors.lastname: Guerrera
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002216:Captopril / Q000009:adverse effects* / Q000494:pharmacology; D004656:Enalapril / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000139:chemically induced* / Q000188:drug therapy; D011282:Pregnenediones / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D000893:Anti-Inflammatory Agents; D011282:Pregnenediones; D004656:Enalapril; D002216:Captopril; C021988:deflazacort