Development of familial benign chronic pemphigus in a patient undergoing treatment with efalizumab for psoriasis

© 2008 The Authors JEADV 2009, 23, 570–620 Journal compilation © 2008 European Academy of Dermatology and Venereology (anticholinergic drugs or radiotherapy), destruction of the gustatory epithelium by antimitotic agents, transduction signal disorders, or structural disturbance of sensory receptors, implying metallic cations are often suggested. Zinc or copper deficiencies are involved in dysgeusia. As a matter of fact, zinc seems to be essential to a protein named gustin taking part in the gustatory cytoarchitecture.4 Preferential interactions between zinc and metallic cations have been demonstrated with propylthiouracil which contains a sulfhydryl group (SH)5 and suggested with several other drugs (particularly angiotensine-converting enzyme inhibitors and antagonists of the angiotensin receptor which are zinc chelators).6 The chemical components of the two synthetic antimalarials used in that case are very close in so far as the single difference is a hydroxyl group (OH). Moreover SH and OH groups share some similar chemical bonding properties. As a consequence, we draw the hypothesis that hydroxychloroquine may enhance risk of ageusia through interactions with zinc, especially in case of xerostomia. Alternative treatment consists to switch with chloroquine. Zinc supplementation could be an interesting option to try.