Pemphigus herpetiformis associated with prostate cancer

696 © 2006 The Authors JEADV 2007, 21, 681–721 Journal compilation © 2006 European Academy of Dermatology and Venereology Miltefosine inhibits phospholipid and sterol biosynthesis of trypanosomids and is effective in vivo against Leishmania. It is administered orally for 28 days (2.5 mg/kg/day). Phase 2 and 3 trials against visceral leishmaniasis in India demonstrate a 97% cure rate, although no specific trials have been planned for the cutaneous form. Motion sickness and nausea have been reported by 30% of patients, as well as vomiting in 75% of them. However, patients do not usually stop the therapy for this reason. We want to emphasize various points in the present case. First of all, our patient was not immunocompromised. Chronic use of immunosuppressive drugs (prednosine, cyclosporin), or other immunocompromised states such as HIV infection lead to impairment of immunological mechanisms of the host, facilitating the multiplication of the parasite and its dissemination. This chronic form is quite atypical considering that photoexposed areas are the most commonly affected. It is also interesting that therapy with pentavalent antimonials was unsuccessful in this case. Miltefosine should be considered as an alternative and as an oral agent with an acceptable toxicity, with a higher cure rate than other promising agents for cutaneous leishmaniasis such as itraconazol or allopurinol, including in endemic areas such as southern Spain.