Gold Sodium Thiomalate Treatment of Pemphigus

Penneys, Neal S.; Eaglstein, William H.; Indgin, Sidney N.; Frost, Phillip

doi:10.1001/archderm.1973.01620220028007

Cited by 67 publications

(28 citation statements)

References 7 publications

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“…The clinical characteristics of the patients, course of gold treatment, response to therapy, and incidence and type of toxicity have been reported previously (8). Skin biopsies were obtained from 4 patients with pemphigus who were treated with an identical program of gold sodium thiomalate (16), and from 4 additional patients with active rheumatoid arthritis who developed gold dermatitis during chrysotherapy.…”

Section: Materials and Methods Patientsmentioning

confidence: 99%

Gold concentrations in hair, nail, and skin during chrysotherapy

Gottlieb

Smith

Penneys

et al. 1974

Arthritis & Rheumatism

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Serial hair and nail specimens were obtained from 18 patients with rheumatoid arthritis receiving chrysotherapy. Punch biopsies of skin lesions and normal-appearing skin from 4 other patients with gold dermatitis, and serial skin biopsies from 4 additional patients were obtained at intervals during chrysotherapy. Gold content was measured in these samples using neutron activation analysis. Small quantities of gold were found in hair (mean = 0.30 pg/g), nail (mean = 0.17 pg/g), and skin (mean = 0.03 pg/g) prior to chrysotherapy, with two-to fivefold increases after 3-12 months of treatment. Compared to those from patients who did not develop gold toxicity, gold concentrations in all three tissues were similar in patients who developed gold toxicity. Gold levels were identical in skin lesions and normal-appearing skin of patients with gold dermatitis. These findings indicate that gold has little affinity for keratinous tissues, and that determination of gold content in these tissues is not helpful in differentiating gold-toxic from nontoxic patients.Recent studies (1,2) have confirmed earlier reports (3) of the efficacy of gold compounds in the treatment of rheumatoid arthritis (RA). Although gold compounds

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Section: Materials and Methods Patientsmentioning

confidence: 99%

Gold concentrations in hair, nail, and skin during chrysotherapy

Gottlieb

Smith

Penneys

et al. 1974

Arthritis & Rheumatism

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“…14 Gold therapy has been restarted after minor toxic effects such as dermatitis and mild proteinuria resolve, without a recurrence of adverse effects. 1,14 A recent report 11 recommends a combined dermatologist and rheumatologist approach to the treatment of pemphigus with gold. While all patients receiving high doses of corticosteroids should be followed up by a primary care physician to monitor cardiac, pulmonary, and renal status, we have not found it necessary to consult with rheumatologists aslongascarefulmonitoringofthepatientisperformed.Rheumatologists are well versed in the treatment of rheumatoid arthritis with gold and may be helpful in assisting dermatologists when initiating gold therapy; however, the dermatologist will ultimately make most therapeutic decisions in patientswithpemphigusbasedonanexaminationoftheskin.…”

Section: Methodsmentioning

confidence: 99%

“…The time to halving of prednisone dosage was 3 months, which is longer than the expected 6-week lag time noted previously for initial responses. 1 This delay is longer than thatwhichhasbeenreportedforothersteroid-sparingagents, which may be unacceptable for seriously ill patients who manifest numerous adverse effects from steroid therapy. However, this delay may also account for patients who have been identified as unresponsive to the use of gold but have not been treated for an adequate period to assess a response.…”

Section: Commentmentioning

confidence: 99%

“…Only 1 of these patients (patient 15) has had a mild relapse of disease, requiring only gold therapy to achieve control. Seven patients (patients 1,5,7,8,17,19, and 22) discontinued use of prednisone and were free of disease at the end of the study, but were still receiving gold. Four of these patients (patients 1, 5, 7, and 8) have had mild recurrences that responded to short (Ͻ2-month) courses of prednisone.…”

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Treatment of Pemphigus With Gold

Pandya¹,

Dyke²

1998

Arch Dermatol

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Background: Although gold has been reported to be useful in treating pemphigus vulgaris, its use has waned in recent years because of concerns regarding efficacy and toxicity.Objective: To review 26 patients with pemphigus who were treated with intramuscular gold over a 10-year period.Results: Gold was effective in 62% of patients as a primary treatment for pemphigus or as a steroid-sparing agent. An average of 3 months of therapy was required before the daily prednisone dosage could be halved. Four patients were free of disease and stopped receiving all therapy at the conclusion of the study. Toxic effects due to gold therapy developed in 42% of patients and all adverse effects resolved with its cessation. Conclusions: While toxic effects limit the use of gold in many patients with pemphigus, it may be effective in treating a large percentage of patients who otherwise are unable to reduce their steroid requirement. Because of its delayed onset of action, patients treated with gold usually require systemic steroids when therapy is initiated. Controlled, prospective trials are needed to further evaluate the efficacy of gold and its potential steroid-sparing effects.

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“…The systemically administered immunosuppressive drugs, al though given in high concentrations, did not affect Langerhans' cell ATPase staining [18]. Our patients were treated with GST ac cording to Blitstein-Willinger [3] and Penneys et al [16].…”

Section: Introductionmentioning

confidence: 97%

Behavior of Cutaneous Langerhans’ Cells and Skin Reactivity after Gold Sodium Thiomalate Treatment of Pemphigus vulgaris

Blitstein-Willinger¹

1987

Dermatology

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Skin biopsies from pemphigus vulgaris patients in the acute phase of disease and after successful GST therapy were studied in respect to their capacity to express OKT₆, OKI_a1 and HLA-DR antigens. In comparison to controls, the epidermis overlaying noninvolved skin contained significantly (p = 0.0001) fewer detectable la and T₆ antigen-bearing Langerhans’ cells. Lower epidermal Langerhans’ cell density in comparison to controls was detected in both prednisolone-treated and untreated patients. A normalization of prior defective antigen expression was observed in patients in remittence after GST therapy. This correlated with a normal delayed type hypersensitivity reaction (Multitest Mérieux).

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Gold Sodium Thiomalate Treatment of Pemphigus

Cited by 67 publications

References 7 publications

Gold concentrations in hair, nail, and skin during chrysotherapy

Gold concentrations in hair, nail, and skin during chrysotherapy

Treatment of Pemphigus With Gold

Behavior of Cutaneous Langerhans’ Cells and Skin Reactivity after Gold Sodium Thiomalate Treatment of Pemphigus vulgaris

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