The Management of Oral Pemphigus Vulgaris with Systemic Corticosteroid and Dapsone

Azizi, Arash; Lawaf, Shirin

doi:10.5681/joddd.2008.007

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…We have listed a summary of treatment options and treatment outcomes of oral PV patients in studies published up to this point in Table 5 [ 8 , 11 , 12 , 15 , 16 , 19 , 25 – 36 ]. Combination therapy with various adjuvants has long been a subject of interest, and numerous studies have evaluated their efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroids have been the mainstay of treatment of PV since the time of their approval in the 1950s [ 14 ]. Although topical corticosteroid therapy is used in cases where the PV is not extensive, and lesions are exclusively oral, systemic corticosteroids are the mainstay of treatment of oral lesions [ 15 , 16 ]. The optimum corticosteroid dosing and tapering strategies are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran

Davarmanesh

Zahed

Sookhakian

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background Treating oral mucosal lesions of Pemphigus Vulgaris (PV) disease is usually challenging for clinicians. We studied the treatment outcomes of the oral PV patients referred to the Oral Medicine Department of Shiraz University of Medical Sciences from 2004 to 2018. Methods The medical records of 54 oral PV patients with histopathological confirmation who were treated by a single protocol were studied. The protocol consisted of initial treatment with 1 mg/kg/day of oral prednisolone for all patients. After 4–6 weeks, all patients were prescribed 40 mg of prednisolone. If lesion recovery was not observed or new lesions had developed, adjuvant therapy (maximum dose of 200 mg per day of Azathioprine (AZA)) was initiated anytime during the treatment. The oral prednisolone dosage was gradually tapered to 5 mg/alternate day in 9 months. Results 47 patients were included in the study. 34.04% were male and 65.96% were female with a mean age of 41.83 ± 12.520. The mean follow-up period was 50.806 ± 44.417 months (over 4 years). The severity of oral involvement was mild in 21.27%, moderate in 36.17%, and severe in 42.6%. During treatment, all patients except one experienced complete remission. The mean time to achieve complete remission was 150.39 ± 224.075 days. Most of the patients experienced relapse due to self-discontinuation of treatment. 55% had complete remission and 43% were in partial remission at the last follow-up session. In 65.96% of patients, treatment-associated side effects were observed. The patients treated with prednisolone alone had significantly more side effects than those using AZA as an adjuvant (80% vs 50%, respectively; P =0.030). The mean duration of follow-ups was longer for patients with side effects ( P < 0.01). Topical corticosteroids were used for all patients sometime during the treatment. No deaths were recorded. Conclusion Prescribing low-dose prednisolone and adding AZA in nonresponding cases has good clinical outcomes for the treatment of oral lesions of PV. Adjuvant therapy can avoid the increase in corticosteroid dosage and side effects. The treatment method described in this study can be a helpful guide for clinicians, especially when other immunosuppressive drugs are not available.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran

Davarmanesh

Zahed

Sookhakian

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Management of Suspected Pemphigus Vulgaris in Elderly Patient with Chronic Diseases

Prihanti

Jusri²

2013

J Dent Indones

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Pemphigus vulgaris (PV) is a group of vesicobullous disease that affects skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3 on desmosome. The lesion of PV is a thin-walled bulla arising on the normal skin or mucosa. The bulla of oral mucous are more fragile and rapidly break down, forming irreguler ulcers. There are several factors that can trigger PV including genetic factors, age, drugs and food. The purpose of this paper was to report the treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75- year-old woman with 2 months history of bulla formation on skin and about a month history of persistent oral ulceration. Ulcers were covered hypertension, diabetes mellitus and hepatitis. On routine complete blood count was found thrombocytopenia.distinguished from other vesicobullous disease. Systemic corticosteroid therapy was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of PV and thus require more intensive and comprehensive treatment. ABSTRAK(PV) adalah kelompok penyakit vesikulobulosa yang dapat mengenai kulit dan membran mukosa. PV merupakan penyakit autoimun dengan karakteristik adanya ikatan antara autoantibodi IgG dengan desmoglein 3 pada desmosom. Lesi PV merupakan bula berdinding tipis yang timbul pada kulit dan mukosa yang terlihat normal. Bula pada mukosa oral sangat mudah pecah dan membentuk ulser. Terdapat beberapa faktor yang dapat mencetuskan PV meliputi faktor genetik, usia, pemakaian obat-obatan dan makanan. Tulisan ini melaporkan penatalaksanaan kasus yang diduga adalah PV yang terjadi pada lansia dengan riwayat penyakit kronis. Kasus adalah wanita berusia 75 tahun dengan riwayat adanya lesi bula di kulit sejak eritema pada mukosa labial, bukal, dan gingiva. Terdapat riwayat hipertensi, diabetes mellitus, hepatitis, dan trombositopenia. Diagnosis PV ditegakkan berdasarkan keluhan subjekif dan klinis yang dapat dibedakan dengan penyakit vesikobulosa yang lain. Kortikosteroid sistemik diberikan bersama hepato protektor, obat kumur, terapi suportif, dan krim bibir. Bula pada kulit dan ulserasi yang menetap pada mukosa oral adalah manifestasi PV. Pada pasien lansia ini keadaan sistemiknya membutuhkan penatalaksanaan yang lebih intensif dan komprehensif.Key words: autoimmune disease, chronic disease, elderly patient, pemphigus vulgaris PENDAHULUAN Pemphigus vulgaris (PV) yang merupakan kelompok penyakit vesikobulosa, menyerang kulit dan membran mukosa. Lesi pada mukosa rongga mulut ditemukan pada sekitar 80-90% pasien PV dan 60% kasus mempunyai tanda awal PV pada mukosa rongga mulut. [1][2][3][4] Etiologi PV berkaitan dengan reaksi autoimun yaitu terjadinya ikatan antara imunoglobulin G (IgG) autoantibodi dengan protein desmosom sel keratinosit di bawah permukaan stratum spinosum yaitu desmoglein (Dsg) 1 dan 3 glikoprotein transmembran.5 Antibodi PV bereaksi hanya pada antigen per...

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The Management of Oral Pemphigus Vulgaris with Systemic Corticosteroid and Dapsone

Cited by 2 publications

References 17 publications

Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran

Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran

Management of Suspected Pemphigus Vulgaris in Elderly Patient with Chronic Diseases

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