Dexamethasone cyclophosphamid pulse therapy in pemphigus-appraisal of its outcome

Introduction :- Pemphigus is the commonest autoimmune vesicobullous disorder on the the Indian subcontinent. the mainstay of treatment of the disease is systemic steroid and other immunosuppresive therapies. Dexamethasone-cyclophosphamide(DCP) pulse therapy was designated by pasricha for pemphigus i...

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Bibliographic Details
Main Authors: Prabhash Kulhari, Urmila Baruah
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2012-01-01
Series:Indian Dermatology Online Journal
Subjects:
Online Access:http://www.idoj.in/article.asp?issn=2229-5178;year=2012;volume=3;issue=10;spage=9;epage=9;aulast=Kulhari
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Summary:Introduction :- Pemphigus is the commonest autoimmune vesicobullous disorder on the the Indian subcontinent. the mainstay of treatment of the disease is systemic steroid and other immunosuppresive therapies. Dexamethasone-cyclophosphamide(DCP) pulse therapy was designated by pasricha for pemphigus in 1981 with the aim of reducing toxicity of corticosteroid and also achieve better results. Method:- Thirty one patients admitted at department of dermatology ASSAM MEDICAL COLLEGE,DIBRUGARH were enrolled for study prospectively from 2008-2011.Diagnosis of pemphigus was based on clinical feature, tzanck smear and biopsy. Confirmation was carried out by direct immunofluorascence.DCP pulse was given to confirmed cases of pemphigus. we enrolled 31 patients with pemphigus for DCP pulse therapy in our hospital during this period out of which 27 patients were pemphigus vulgaris and 4 were pemphigus folIacious. male to female ratio was 1.2:1.Of 31 patients enrolled for this treatment,6 patients could not complete the treatment and 2 patient died due to cardiovascular failure(not related to treatment). Of remaining 23 patients ,15 have alredy completed the treatment and are free of disease even after withdrawl of all treatment. 5 patients are in remission but have not completed the treatment schedule whereas 3 patients are still having clinical evidence of disease although it has already become much milder .Various side effects seen in our patients were candidiasis (2),tuberculosis(1)), acneiform eruption(2), osteoporosis(1), cataract(2), hair fall(2), gastritis(3), avascular necrosis(1).Our finding are very consistent with previous reports that DCP pulse therapy is very effective in pemphigus and having lesser side effects in comparison to daily steroid .
ISSN:2229-5178