Treatment of Pemphigus with Corticosteroids

The events leading to the death of patients with pemphigus and pemphigoid

“…Perhaps in such centres, as most publications suggest, the skin disease is indeed rapidly suppressed, but the overall picture of patients treated in England and Wales over an 8 year period is very different. The steroid dosages used were often lower than those usually recommended (Lever & White, 1963), and a lack of response to treatment, perhaps even undertreatment, with persistent skin lesions and electrolyte changes, must have been an important part in the chain of events leading to the death of many of these patients. In the present study, patients with pemphigoid were found to have had as marked electrolyte and protein changes as those with pemphigus vulgaris.…”

Methotrexate and Prednisone in Pemphigus Vulgaris

“…Of the 12 patients, eight were liv¬ ing on Sept 1,1971. Five of the eight were free of lesions without further treatment.…”

“…One patient (case 23) required a second high-dosage course because of the breakthrough of oral and cuta¬ neous lesions; and the other patient ( 1,1971. Two of them had been free of lesions for 12 and 5 months, respec¬ tively (cases 29 and 30).…”

“…Twenty-four of 36 patients with pemphigus vulgaris were treated with methotrexate alone or in various combinations with prednisone, All 24 patients were living and in good condition when reexamined on Sept 1,1971. Eight patients were free of lesions, whereas 16 patients still had some lesions, predominantly in the mouth.…”

Azathioprine in pemphigus vulgaris.

“…Systemic cortioosteroids in high doses will usually suppress the disease, but in most cases maintenance therapy must be continued indefinitely (Lever and White, 1963), and many patients develop side-effects from this treatment. The disease may be due to an immunological disorder (Beutner et al, 1968), and immunosuppressive drugs therefore offer a rational alternative to corticosteroid therapy.…”