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Penicillamine revisited: historic overview and review of the clinical uses and cutaneous adverse effects.
[cystinuria]
Penicillamine
is
a
well-known
heavy
metal
chelator
,
classically
used
in
the
treatment
of
Wilson
disease
,
rheumatoid
arthritis
,
and
cystinuria
.
From
a
dermatologic
standpoint
,
penicillamine
was
found
to
be
useful
in
the
treatment
of
systemic
sclerosis
.
The
successful
therapeutic
uses
of
penicillamine
have
been
hindered
by
its
numerous
adverse
effects
,
both
cutaneous
and
extra
-
cutaneous
.
It
is
a
unique
drug
since
it
provokes
a
diversity
of
dermatologic
manifestations
that
include
(
1
)
acute
hypersensitivity
reactions
,
(
2
)
dermopathies
characterized
by
elastic
fiber
abnormalities
including
elastosis
perforans
serpiginosa
and
pseudo-
pseudoxanthoma
elasticum
,
(
3
)
autoimmune
disorders
such
as
pemphigus
and
penicillamine-induced
lupus
erythematosus-like
syndrome
,
and
(
4
)
miscellaneous
dermatoses
that
result
from
undefined
mechanisms
.
These
cutaneous
adverse
effects
may
correlate
with
the
dosage
and
duration
of
penicillamine
therapy
as
well
as
the
disease
being
treated
.