Recalcitrant Cicatricial Pemphigoid Treated With the Anti-TNF-Alpha AgentEtanercept
January 2010 | Volume 9 | Issue 1 | Case Reports | 68 | Copyright © January 2010
Maj. Jeremy Scott Kennedy DO, Col. (Ret) Richard L. Devillez MD, Maj. Jeffrey Scott Henning DO
Cicatricial pemphigoid (mucous membrane pemphigoid) is a group of chronic disorders characterized by recurrent subepithelial blisters
and scarring, predominantly of the mucous membranes.1,2 The authors report the case of a 63-year-old female with a 20-year
history of cicatricial pemphigoid who had failed treatment with cytoxan, dapsone, systemic steroids and minocycline. She achieved
complete clinical remission with the addition of etanercept 50 mg twice a week with azathioprine 150 mg daily. This patient has
remained clear for two years with this combination and has tolerated a tapering of the azathioprine from the initial dose of 250 mg.
Etanercept is a recombinant human dimeric fusion protein which acts as a competitive inhibitor of TNF-alpha by binding to both
soluble and receptor-bound molecules of TNF-alpha.14 There have been a few reports of successful use of TNF-alpha inhibitors in
cicatricial pemphigoid. This report will discuss the possible mechanism of action of the addition of TNF-alpha inhibitors as a steroidsparing
agent in these patients.