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(21) Can pemphigus be cured?
Author(s) -
Pasricha J.S.
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.tb12039.x
Subject(s) - cyclophosphamide , dexamethasone , medicine , pemphigus , chemotherapy , surgery , gastroenterology , dermatology
In 1981, we started using an arbitrarily designed regime for pemphigus, consisting of 100 mg dexamethasone dissolved in 5% glucose given by an intravenous drip over 1 h, daily on three consecutive days (pulse) and repeated every month. This was later modified with the addition of 500 mg cyclophosphamide along with the dexamethasone on the first day and 50 mg cyclophosphamide daily orally in between the pulses. Treatment can be divided into four phases. During phase I, the patient continues to develop relapses of pemphigus within a variable number of days after the pulse but the lesions heal quickly. The relapses become progressively milder and stop after a few months, but the dexamethasone‐cyclophosphamide pulses are continued once a month; this is called phase II, and lasts from 6 to 9 months. In phase III, the monthly pulses are stopped but the patient continues to take 50 mg cyclophosphamide orally per day. After a year or so, all treatment is withdrawn and the patient is observed for any relapses (phase IV). Fifty‐seven patients have been enrolled in the last 4 years. Four are now without any treatment (phase IV), 12 are only on 50 mg cyclophosphamide a day (phase III), another 12 are in remission but still taking dexamethasone‐cyclophosphamide (phase II), and 24 patients still have active disease (phase I). Four patients have been lost to follow‐up and one has died. Side‐effects of corticosteroids have not been observed. Our results indicate that it is possible to induce long remissions, and maybe cure, pemphigus with this regime.