Case of bullous pemphigoid refractory to corticosteroids by antiepileptic drug‐induced CYP3A4

The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug‐metabolizing enzyme in the liver, metabolizes synthetic steroids to a varying degree. Although there are many CYP3A4‐inducing drugs, several antiepileptic drugs, such as phenytoin and ph...

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Published inJournal of dermatology Vol. 50; no. 2; pp. 254 - 257
Main Authors Asakawa, Riko, Ogawa, Youichi, Maejima, Eri, Honobe‐Tabuchi, Akiko, Okamoto, Takashi, Mitsui, Hiroshi, Kagawa, Yoshiyuki, Shimada, Shinji, Kawamura, Tatsuyoshi
Format Journal Article
LanguageEnglish
Published England Wiley Subscription Services, Inc 01.02.2023
Subjects
Adrenal Cortex Hormones - therapeutic use
Anticonvulsants - therapeutic use
Antiepileptic agents
antiepileptic drugs
Bullous pemphigoid
Case reports
Corticosteroids
CYP3A4
Cytochrome P-450 CYP3A - therapeutic use
Humans
Pemphigoid, Bullous - drug therapy
Phenobarbital
Phenobarbital - therapeutic use
Phenytoin
Phenytoin - therapeutic use
Skin diseases
Steroid hormones
antiepileptic drugs
bullous pemphigoid
corticosteroids
CYP3A4
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Abstract The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug‐metabolizing enzyme in the liver, metabolizes synthetic steroids to a varying degree. Although there are many CYP3A4‐inducing drugs, several antiepileptic drugs, such as phenytoin and phenobarbital, strongly induce CYP3A4, thereby reducing the effects of corticosteroids. Here, we report a case of refractory bullous pemphigoid that rapidly improved after the discontinuation of phenytoin and phenobarbital. To achieve adequate pharmacological effects of corticosteroids, we must always ensure that patients who require corticosteroids for treatment are not medicated with CYP3A4‐inducing agents.
AbstractList The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug-metabolizing enzyme in the liver, metabolizes synthetic steroids to a varying degree. Although there are many CYP3A4-inducing drugs, several antiepileptic drugs, such as phenytoin and phenobarbital, strongly induce CYP3A4, thereby reducing the effects of corticosteroids. Here, we report a case of refractory bullous pemphigoid that rapidly improved after the discontinuation of phenytoin and phenobarbital. To achieve adequate pharmacological effects of corticosteroids, we must always ensure that patients who require corticosteroids for treatment are not medicated with CYP3A4-inducing agents.The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug-metabolizing enzyme in the liver, metabolizes synthetic steroids to a varying degree. Although there are many CYP3A4-inducing drugs, several antiepileptic drugs, such as phenytoin and phenobarbital, strongly induce CYP3A4, thereby reducing the effects of corticosteroids. Here, we report a case of refractory bullous pemphigoid that rapidly improved after the discontinuation of phenytoin and phenobarbital. To achieve adequate pharmacological effects of corticosteroids, we must always ensure that patients who require corticosteroids for treatment are not medicated with CYP3A4-inducing agents.
The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug-metabolizing enzyme in the liver, metabolizes synthetic steroids to a varying degree. Although there are many CYP3A4-inducing drugs, several antiepileptic drugs, such as phenytoin and phenobarbital, strongly induce CYP3A4, thereby reducing the effects of corticosteroids. Here, we report a case of refractory bullous pemphigoid that rapidly improved after the discontinuation of phenytoin and phenobarbital. To achieve adequate pharmacological effects of corticosteroids, we must always ensure that patients who require corticosteroids for treatment are not medicated with CYP3A4-inducing agents.
Author Kawamura, Tatsuyoshi
Ogawa, Youichi
Kagawa, Yoshiyuki
Mitsui, Hiroshi
Okamoto, Takashi
Maejima, Eri
Shimada, Shinji
Asakawa, Riko
Honobe‐Tabuchi, Akiko
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Keywords antiepileptic drugs
bullous pemphigoid
corticosteroids
CYP3A4
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Snippet The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug‐metabolizing enzyme in the liver, metabolizes...
The most common treatment option for patients with bullous pemphigoid is systemic corticosteroids. CYP3A4, a drug-metabolizing enzyme in the liver, metabolizes...
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StartPage 254
SubjectTerms Adrenal Cortex Hormones - therapeutic use
Anticonvulsants - therapeutic use
Antiepileptic agents
antiepileptic drugs
Bullous pemphigoid
Case reports
Corticosteroids
CYP3A4
Cytochrome P-450 CYP3A - therapeutic use
Humans
Pemphigoid, Bullous - drug therapy
Phenobarbital
Phenobarbital - therapeutic use
Phenytoin
Phenytoin - therapeutic use
Skin diseases
Steroid hormones
Title Case of bullous pemphigoid refractory to corticosteroids by antiepileptic drug‐induced CYP3A4
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https://www.ncbi.nlm.nih.gov/pubmed/36317542
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