Pemphigus foliaceus induced by penicillamine.

Pemphigus foliaceus induced by penicillaminePenicillamine is being used increasingly in the management of rheumatoid arthritis.It is the treatment of choice in Wilson's disease and cystinuria, but, as both of these disorders are rare, only relatively few patients have received the drug.Rashes occur in up to 60% of patients with Wilson's disease and cystinuria on penicillamine.1-3A much lower incidence is reported in rheumatoid arthritis (13-25%), possibly because smaller doses are given and the drug is introduced more cautiously.4Morbilliform and urticarial eruptions are the most common lesions and they usually appear within the first 10 days of treatment.Withdrawing treatment leads to prompt recovery and the drug can usually be reintroduced without the rash recurring.Blistering and bruising with wrinkled scars and milia may occur on areas exposed to pressure and injury in patients with Wilson's disease or cystinuria, usually after the first year of treatment.5 6 Such lesions, as well as elastosis perforans serpiginosa,7 are probably related to penicillamine's lathyrogenic effects on connective tissues; they improve if the dose is Goodpasture's syndrome.