Therapeutic plasma exchange as a crisis option in severe pemphigus vulgaris

Ranugha, P. S. S.; Kumari, Rashmi; Kartha, Lakshmi Bhuvaneshwaran; Parameswaran, Sreejith; Thappa, Devinder Mohan

doi:10.4103/0378-6323.98092

Cited by 11 publications

(3 citation statements)

References 6 publications

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“…No standardized protocol for the number and frequency of sessions of plasmapheresis exists; however, four or five plasma exchanges – each consisting of 1–1.5 plasma volumes over a period of 7–10 days – represent an adequate short-term treatment to remove 90% of the total initial body immunoglobulin burden. 10 , 89 Other experts recommend 1–2 sessions per week. 77 Plasmapheresis can be undertaken by using the conventional centrifugation device utilized in blood banks.…”

Section: Corticosteroidsmentioning

confidence: 99%

Emerging treatment options for the management of pemphigus vulgaris

Kridin¹

2018

TCRM

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Pemphigus vulgaris (PV) is a life-threatening disease belonging to the pemphigus group of autoimmune intra-epidermal bullous diseases of the skin and mucosae. The therapeutic management of PV remains challenging and, in some cases, conventional therapy is not adequate to induce clinical remission. The cornerstone of PV treatment remains systemic corticosteroids. Although very effective, long-term corticosteroid administration is characterized by substantial adverse effects. Corticosteroid-sparing adjuvant therapies have been employed in the treatment of PV, aiming to reduce the necessary cumulative dose of corticosteroids. Specifically, immunosuppressive agents such as azathioprine and mycophenolate mofetil are widely used in PV. More recently, high-dose intravenous immunoglobulins, immunoadsorption, and rituximab have been established as additional successful therapeutic options. This review covers both conventional and emerging therapies in PV. In addition, it sheds light on potential future treatment strategies for this disease.

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Section: Corticosteroidsmentioning

confidence: 99%

Emerging treatment options for the management of pemphigus vulgaris

Kridin¹

2018

TCRM

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“…There is no standardized protocol for the number and frequency of sessions; however, four or five plasma exchanges, each exchange consisting of 1–1.5 plasma volumes, over a period of 7–10 days constitute an adequate short-term therapy to remove 90% of the total initial body immunoglobulin burden. 59 …”

Section: Other Therapeutic Strategiesmentioning

confidence: 99%

Management of pemphigus vulgaris: challenges and solutions

Gregoriou¹,

Efthymiou²,

Stefanaki³

et al. 2015

CCID

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The main objective in the treatment of pemphigus vulgaris is to control the disease, prevent relapses, and avoid adverse events associated with the prolonged use of steroids and immunosuppressive agents. Systemic corticosteroids remain the gold standard treatment for pemphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid-sparing treatment. Rituximab is extremely effective in recalcitrant pemphigus, when other treatments fail to control the disease. The European Dermatology Forum recommends tapering prednisolone by 25% every 2 weeks after the consolidation phase, and a 5 mg reduction every 4 weeks when the dose is reduced to <20 mg. If the patient relapses, options include increasing steroids back to the previous dose, adding an immunosuppressant if using steroid monotherapy, or replacing a first-line immunosuppressant by another if already on combination therapy.

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“…Manejo estomatológico y sistémico de pénfigo vulgar: reporte de un caso La fotoquimioterapia extracorpórea implica la recolección de células mononucleares con un separador celular, su irradiación con luz ultravioleta-A (uv-a) en presencia de 8-metoxipso-ralen y la reinfusión de las células tratadas en el paciente. El mecanismo de acción no ha sido totalmente iluminado (20).…”

Section: Introductionunclassified

Manejo estomatológico y sistémico de pénfigo vulgar: reporte de un caso

et al. 2018

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Introducción: el pénfigo vulgar es una enfermedad autoinmune poco común de piel y mucosas, su etiología es desconocida y presenta una elevada tasa de mortalidad. Las manifestaciones de esta patología son comunes en cavidad bucal; por ende, el odontólogo tiene una gran responsabilidad en realizar un diagnóstico oportuno y, de esta manera, mejorar el pronóstico. Presentación del caso: paciente sexo femenino de 63 años con diagnóstico de pénfigo vulgar y lesiones en cavidad bucal y piel; el tratamiento se realizó en equipo entre el departamento de estomatología y dermatología. El manejo sistémico fue con prednisolona en dosis altas que disminuían en periodos determinados; además, se medicó con inmunosupresor, antihistamínico, antibióticos y antimicóticos. Para tratar las lesiones en cavidad bucal se utiliza una fórmula magistral compuesta por hidrocortisona, vitamina A, E, glicerina de bajo peso molecular y xilocaína en orabase aplicada en las lesiones. El tratamiento se realizó por 4 meses, a la primera semana se logró la resolución de la sintomatología en cavidad bucal y piel; se logró la cicatrización completa de todas las lesiones y no se registró recidiva luego de culminado el tratamiento. Conclusión: la literatura coindice en que la prednisolona es el medicamento de elección para tratar dicha patología, se encuentra que un diagnóstico oportuno evitaría el uso de estos medicamentos en altas dosis y por largos periodos, evitando así reacciones adversas; el uso de la fórmula magistral para lesiones en cavidad bucal no se reporta en la literatura, por ende, se considera importante su divulgación.

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Therapeutic plasma exchange as a crisis option in severe pemphigus vulgaris

Cited by 11 publications

References 6 publications

Emerging treatment options for the management of pemphigus vulgaris

Emerging treatment options for the management of pemphigus vulgaris

Management of pemphigus vulgaris: challenges and solutions

Manejo estomatológico y sistémico de pénfigo vulgar: reporte de un caso

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