Evaluation of Response of Parenteral Dexamethasone in Pemphigus Vulgaris (original) (raw)
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Adverse effects of parenteral dexamethasone in the treatment of pemphigus vulgaris
Bangabandhu Sheikh Mujib Medical University Journal, 2016
Background: Pemphigus vulgaris is associated with high morbidity as well as significant mortality rate. Today the risk of death in pemphigus from the side effect of oral prednisolone is greater than risk of death from the disease itself. Objective: To observe the adverse effects of parenteral dexamethasone compared with oral prednisolone in the treatment of pemphigus vulgaris. Methods: An interventional study was carried out in the department of Dermatology and Venereology, Bangabandu Sheikh Mujib Medical University, Dhaka, Bangladesh. Total number of patients was thirty and among them fifteen patients were treated with parenteral dexamethasone (Group-A) and other fifteen were treated with oral prednisolone (Group-B). Results: The study showed statistically significant differences of skin lesion as well as mucosal lesion of pemphigus after 6 weeks of therapy between of two groups (P<0.05). The most common adverse effects were increased body weight(40%), increased appetite(40%),...
IOSR Journals , 2019
We carried out a clinical study in the. Our aim was to evaluate the efficacy and safety of three currently used treatment modalities for pemphigus. Sixty (60) patients of pemphigus (pemphigus vulgaris and severe cases of pemphigus vegetans, pemphigus foliaceous and pemphigus erythematosus) were divided into three groups. Thirty (30) patients were treated with Prednisolone, Fifteen (15) with a combination of Prednisolone plus azathioprine and 15 patients with betamethasone-cyclophosphamide pulse (BC) therapy. All patients were followed from 10 to 20 months (mean 15 months), There was no statistical difference between steroid and azathioprine-corticosteroid therapy groups in terms of time taken to achieve initial control of the disease but the frequency of relapses and the incidence of complications were higher in patients treated with corticosteroids alone (p<0.05). A marginally increased susceptibility to infections was seen in patients treated with BC therapy as compared with azathioprine-corticosteroid group (p=O.07). Sixty (60) percent patients treated with BC therapy required additional steroids in between the monthly pulses, indicating failure of BC? as sole therapy. It was concluded that azathioprine-corticosteroid treatment of pemphigus was more effective and comparatively safer than steroid alone or BC therapy.
A preliminary study on clinical outcome of corticosteroid therapy in pemphigus patients
Our Dermatology Online, 2014
Introduction: Pemphigus is life threating blistering of autoimmune disease of the skin and mucous membrane characterised by autoantibodies (auto ABs) against desmoglein-3 (DSG-3). Desmosomal adhesions, protein expressed on the surface of epidermal keratinocytes. Aim: The present study was to assess the incidence rate of pemphigus, to evaluate the clinical course along with clinical manifestations, Complications and Metabolic factors of patients with pemphigus and to investigate the disease severity and induction of remission during the clinical course and whereas to assess the oxidative stress and antioxidant status in pemphigus patients in our hospital. Material and Methods: A prospective study was conducted over a period of January 2012 to December 2012 at dermatology department, MGM Hospital, Warangal. The data was collected from 32 cases of Pemphigus on the basis of Age, Sex, Social Habits, BMI, Histopathological forms, Clinical manifestations and Drug therapy. This hospital is 1200 bedded government hospital provided Outpatient and Inpatient care for Indian citizen especially in Telangana region free of cost. Results: Of the 32 pemphigus patients, 75% were diagnosed with Pemphigus Vulgaris (PV), 12.5% with Pemphigus Foliaceus (PF) and 12.5% with Bullous Pemphigoid (BP). The male to female ratio was approximately 1:1.3. The mean age of onset was 40.8 years in Pemphigus patients. The Onset of disease was 29.85. 34% of patients with Pemphigus had both the mucosal and skin involvement during the clinical course while 25% at the onset of disease. The most common complication was found to be increase blood sugar (40%). Most commonly prescribed adjuvant is dapsone. Majority attained the complete remission and remaining of them attains partial remission. Oxidative stress levels were higher and antioxidant status levels were lower in study subjects when compared to controls. Conclusions: PV is the most common subtype of Pemphigus in our Hospital and usually affects females more than males. Our study reveals that mucosal and skin involvement is common. Corticosteroids and dapsone as adjuvant is majorly prescribed. Most of patients attain complete remission and remaining of them achieves partial remission. Oxidative stress levels were higher and antioxidant status levels were lower in our study subjects when compared to controls.
Journal of Pakistan Association of Dermatology, 2019
Objective To report our 5-year experience in the treatment of pemphigus with dexamethasone-cyclophosphamide pulse therapy, with a slight modification in phase I which resulted in higher rates of remission and no relapses. Methods All patients diagnosed as pemphigus on the basis of clinical and histopathological grounds were started on DCP therapy, but patients in the reproductive age group, both unmarried and those who had not completed their families were started on dexamethasone pulse therapy and Dexamethasone methotrexate pulse therapy was considered in patients with prolonged phase I (>9cycles). Results A total of 51 cases diagnosed with pemphigus were included in the study, of which 21 were males and 30 were females. 49 cases were of Pemphigus vulgaris type and 2 cases were of Pemphigus foliaceus. DCP therapy was started on 46 patients and dexamethasone pulse therapy was started in 5 females of reproductive age group who were yet to complete their families. 2 patients with p...
Advances in the Management of Pemphigus Vulgaris: A Review Article
Global Journal of Medical Research
Pemphigus Vulgaris (PV) is a debilitating autoimmune disease with a genetic predilection. In most cases, PV affects the oral mucosa, but can also occur in conjunction with skin lesions affecting different areas of the body. Lesions affecting the oral mucosa are characterized by the presence of erosions whereas, skin lesions appear mainly as flaccid bulla in their early stages or as erosions later in the disease course. Pemphigus Vulgarisis characterized by the formation of highly fragile bulla that frequently ruptures, forming denuded, painful, easily bleeding erosions that often become crusted. Proper diagnosis is considered a significant component of early and efficient management, resulting in less morbidity. The use of corticosteroids in conjunction with immunosuppressant drugs such as azathioprine and mycophenolatein the management of acute attacks has been applied throughout the years (1).
Twelve-year clinico-therapeutic experience in pemphigus: A retrospective study of 54 cases
International Journal of Dermatology, 2005
Background Pemphigus, a common immunobullous disease of skin and mucous membranes affecting both sexes of all ages, was almost fatal before the advent of corticosteroids. Better strategies to avoid their side-effects and recent introduction of adjuvant therapy has further improved its prognosis. As the treatment remains need-based and patient-specific, different regimens and strategies have evolved, each with its own merits and demerits.This retrospective hospital-based study was carried out to understand the clinico-therapeutic aspects of pemphigus in our clinic.Methods Medical records of all new patients admitted to our hospital with the diagnosis of pemphigus from 1990 to 2002 were analyzed.The diagnosis was mainly clinical and confirmed by positive Tzanck's test and histopathology. All patients were assessed clinically on a severity score of 1+ to 4+.These patients had received treatment with dexamethasone-cyclophosphamide pulse (DCP) therapy, oral mini-pulse (OMP) with betamethasone, or intramuscular triamcinolone acetonide alone or with azathioprine, dapsone or cyclophosphamide. They were followed up for clinical remission and side-effects of therapy.Results There were a total of 54 new patients comprising 53.7% females and 46.3% males, and 12.9% of these were < 18 years of age. Pemphigus vulgaris was the commonest clinical type seen in 81.48% and mucosal involvement was seen in 63.63% of cases. The severity of mucosal lesions was not proportionate to that of cutaneous lesions. Associated diseases seen were seropositive rheumatoid arthritis, hypertension, diabetes mellitus and hyperthyroidism in one case each.Dexamethasone-cyclophosphamide pulse therapy was given to 75% of the pemphigus vulgaris patients while those having less severe disease were treated with other regimens. In general, clinical remission was seen after 2–16 (mean 6.5) DCP doses. Two patients have been in complete remission for the last 5 and 7 years of completion of DCP therapy, respectively. Addition of other adjuvants to corticosteroids was also helpful. However, azathioprine 50 mg/day was not as effective as cyclophosphamide 50 mg/day. Menstrual irregularities, amenorrhoea, azoospermia, rise in blood pressure and glycosuria were the major side-effects seen during DCP pulse therapy. Drop out rate was unacceptably high with all modes of treatment, although with DCP therapy it appears to be partly owing to early disease control. There was no mortality in this series.Conclusions Pemphigus vulgaris is the commonest clinical type. Mucosal surfaces other than the oral cavity are uncommonly involved, it may herald the onset of disease and takes longer to heal. Dexamethasone-cyclophosphamide pulse therapy seems to have a definite advantage over treatment with steroids alone, especially in terms of better control of disease activity, near absence of steroid side-effects and significantly reduced hospital stay. However, ways and means to reduce gonadal toxicity of adjuvants need to be explored as DCP therapy is likely to stay as a treatment of choice.
Outcome of dexamethasone-cyclophosphamide pulse therapy in pemphigus: A case series
Indian Journal of Dermatology, Venereology and Leprology, 2009
Background: Pemphigus disorders are a group of serious and potentially life-threatening diseases affecting skin and/or mucus membranes. Dexamethasone−cyclophosphamide pulse (DCP) therapy has shown promising results in the management of these diseases. Aims: The objective of the study was to assess the outcome of DCP therapy in pemphigus. Methods: Pemphigus patients who had been treated with DCP therapy from 2001 to 2008 were prospectively and retrospectively analyzed. Results: A total of 65 pemphigus patients were enrolled. Male to female ratio was 1 : 1.82. Mean age of patients was 44.65 ± 11.85 years with a range of 14 to 73 years. Thirty two patients completed phase I, of which 28 (9 in phase II, 7 in phase III and 12 in phase III) were maintaining remission and four patients relapsed. Relapse was observed only in patients who discontinued or took irregular treatment. Six patients were declared cured of disease. Five patients died during phase I. Dexamethasone−cyclophosphamide pulse therapy is not absolutely free from adverse effects. Most of the immediate side effects were expected, tolerable and did not pose any problem in continuing treatment. There was a slight increased incidence of weight gain, hypertension, diabetes mellitus, cataract and Cushingoid habitus, since most of our patients also received additional daily oral steroids. Also, there was a high incidence of secondary pyogenic infections of skin lesions and oral candidiasis during phase I. Staphylococcus aureus was the commonest bacteria isolated from the pus of skin lesions. Most of the alterations in laboratory parameters were transitory or correctable, and did not pose a problem in continuing therapy. Conclusions: DCP therapy was found to be effective in inducing and maintaining remission in pemphigus, provided the patients receive regular and complete treatment.
Intermittent high-dose dexamethasone-cyclophosphamide therapy for pemphigus
The British journal of dermatology, 1988
Since 1982, we have treated 79 pemphigus patients with an arbitrarily designed regimen of 100 mg dexamethasone dissolved in 5% glucose given by an intravenous infusion over 1 h, daily on 3 consecutive days and in addition, 500 mg cyclophosphamide on day 1 only. The intermittent high doses (IHD) of dexamethasone are repeated every 2-4 weeks, and the patient continues to take 50 mg/day oral cyclophosphamide. This treatment is divided into four phases. During Phase I, the patient continues to develop relapses of pemphigus a variable number of days after IHD, but the lesions heal up quickly after IHD. These relapses become progressively milder and stop after a few months, but the IHD are continued once a month for 6-9 months (Phase II). In the next phase (Phase III), the monthly IHD are stopped, and the patient continues to take 50 mg/day cyclophosphamide orally. After approximately 1 year this maintenance treatment is withdrawn and the patient is observed for any relapses (Phase IV). O...