Cicatricial pemphigoid associated with D-penicillamine treatment.

Abstract

To the Editor —D-penicillamine is a heavy metal chelator used in the treatment of Wilson's disease, heavy metal poisoning, cystinuria, rheumatoid arthritis, primary biliary cirrhosis, and scleroderma. The administration ofD-penicillamine in the treatment of these diseases has been shown to be effective, but numerous side effects have been observed, among which are the induction of autoimmune diseases of the skin, such as pemphigus, disseminated lupus erythematosus, and dermatomyositis. More autoimmune skin diseases appear to be induced byD-penicillamine when it is used in the treatment of rheumatoid arthritis than when it is used in the treatment of other nonautoimmune diseases. A 54-year-old woman diagnosed in December 1967 to have rheumatoid arthritis developed xerostomia and nonspecific ocular discomfort in 1981, diagnosed as Sjogren's syndrome. Beginning in May 1984, she received treatment with 125 mg/d of indomethacin and 250 mg/d ofD-penicillamine. In April 1985, she