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The use of chlorambucil in the treatment of bullous pemphigoid
Author(s) -
Mllligan A.,
Hutchinson P.E.
Publication year - 1987
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1987.tb12002.x
Subject(s) - chlorambucil , prednisolone , medicine , azathioprine , bullous pemphigoid , gastroenterology , pulmonary embolism , methylprednisolone , surgery , heparinoid , chemotherapy , immunology , heparin , cyclophosphamide , disease , antibody
In the treatment of bullous pemphigoid (BP), the use of azathioprine has been found to decrease the total dosage requirement of systemic steroid by 45%. 1 There is evidence that chlorambucil is a more potent immunosuppressant than azathioprine, but there is scant reference to its use in BP. The aim of the present study was to evaluate the efficacy of chlorambucil in the treatment of BP, with particular reference to its steroid‐sparing capacity. Seventeen consecutive patients with a diagnosis of BP based on clinical, histological and immunological findings were recruited into the study. The only exclusion criterion was an initial platelet count of < 200 × 10 9 /1. The starting dose of prednisolone was 40–60 mg/day and of chlorambucil 5–10 mg/day, following which there was a fixed protocol for dosage reduction. If relapse occurred, the dosage was increased to a previous point on the protocol, depending on severity of relapse, and dosage reduction was re‐started after total suppression of the development of new blisters. The platelet count was carefully monitored and the dosage of chlorambucil was further reduced from the protocol if a consistent decrease was observed, and it was temporarily stopped if a platelet count of < 200 × 10 9 /1 occurred. Fifteen patients completed the therapy and went into complete remission. Two patients died during treatment, one of pneumonia and one of pulmonary embolism and pneumonia. The mean total duration of therapy was less than 6 months. The mean total dosage of prednisolone was < 50% of that reported for prednisolone and azathioprine. It is concluded that chlorambucil is a highly effective treatment for bullous pemphigoid.