Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Treatment of Pemphigus with Corticosteroids: Results Obtained in 46 Patients Over a Period of 11 Years

Treatment of Pemphigus with Corticosteroids: Results Obtained in 46 Patients Over a Period of 11... Abstract Forty-six patients with pemphigus were placed on treatment with corticosteroids between April, 1950, and October, 1959. Their state was determined as of Oct. 1, 1961. There were 32 patients with pemphigus vulgaris, of whom 21 were living and ambulatory on Oct. 1, 1961. Of the 21 living patients, 5 were free of lesions without treatment; 5 were free of lesions but were still receiving treatment; and 11 had a few lesions and were receiving treatment. Eleven patients had died. At the time of death 5 were free of lesions; 4 had a few lesions; and 2 showed extensive involvement. Of the 11 deaths 3 were attributable and 3 probably attributable to therapy with corticosteroids; while 5 patients had died of unrelated causes. One patient with pemphigus vegetans was free of lesions without treatment. Of the 11 patients with pemphigus foliaceus, 6 were free of lesions and without treatment. Five patients had died, 4 of unrelated causes while free of lesions, and I generalized pemphigus foliaceus while not under our care andnot receiving corticosteroids. Of 2 patients with pemphigus erythematosus one was free of lesions and the other had a few lesions. Neither was receiving any treatment. In pemphigus vulgaris early diagnosis and prompt treatment with high doses of corticosteroids is of great importance. If vigorous and prolonged initial treatment is given, it is more likely that the patient can be carried on small maintenance doses than if the initial treatment is less intensive in amount and duration. After the initial administration of high doses the dosage is reduced in a "logarithmic fashion" to the lowest level adequate for maintenance. During exacerbations large doses of corticosteroids are again required. In contrast to early pemphigus vulgaris, treatment may be withheld in early pemphigus foliaceus so long as the disease remains localized and mild. Side-reactions to the corticosteroids were rather common, especially compression fractures of vertebral bodies, bacterial infections, peptic ulcer, and mental changes. In 2 patients central posterior subcapsular cataracts developed as a result of treatment with large doses of corticosteroids. Concurrent administration of testosterone and estrogens was regarded as effective prophylaxis against vertebral fractures. References 1. One cortisone equivalent is equal to 1 tablet of cortisone (25 mg.); 1 tablet of prednisone (5 mg.); 1 tablet of methyl prednisone (4 mg.); 1 tablet of triamcinolone (4 mg.), and one-half tablet of betamethasone (0.3 mg.). 2. Reznick, L.; Lever, W. F., and Frazier, C. N.: Treatment of Pemphigus with ACTH, Cortisone and Prednisone , New Engl. J. Med. 255:305-315 ( (Aug.) ) 1956.Crossref 3. Sanders, S.; Brodey, M., and Nelson, C. T.: Corticosteroid Treatment of Pemphigus , Arch. Derm. 82:717-724 ( (Nov.) ) 1960.Crossref 4. Stoughton, R. B.: Long-Term Management of Pemphigus Vulgaris with Corticotropin (ACTH) , J.A.M.A. 160:1011-1014 ( (March) ) 1956.Crossref 5. Costello, M. J.; Jaimovitch, L., and Dannenberg, M.: Treatment of Pemphigus with Corticosteroids , J.A.M.A. 165:1249-1255 ( (Nov.) ) 1957.Crossref 6. Stevenson, C. J.: Treatment in Bullous Diseases with Corticosteroid Drugs and Corticotrophin , Brit. J. Derm. 72:11-21 ( (Jan.) ) 1960.Crossref 7. Wittels, W.: Ergebnisse der Kortikosteroidtherapie beim Pemphigus vulgaris , Derm. Wschr. 141:401-410 ( (April) ) 1960. 8. Perry, H. O.: Pemphigus Foliaceus , Arch. Derm. 85:52-69 ( (Jan.) ) 1961.Crossref 9. Linton, W. T. R., and Craig, G. E.: Pemphigus: A Comparison of the Results of Treatment at the Royal Victoria Hospital, Montreal, in the Steroid and Presteroid Eras , Canad. Med. Ass. J. 85:1192-1194 ( (Nov.) ) 1961. 10. Per, M. I., and Mashkilleison, A. L.: Remote Results of Continuous Systemic Corticosteroid Treatment in Pemphigus , Dermatologica 124:99-109, 1962.Crossref 11. Lever, W. F.: Pemphigus , Medicine 32:1-123 ( (Feb.) ) 1953.Crossref 12. Oglesby, R. B.; Black, R. L.; Von Sallmann, L., and Bunim, J. J.: Cataracts in Rheumatoid Arthritis Patients Treated with Corticosteroids , Arch. Ophthal. 66:519-523 ( (Oct.) ) 1961.Crossref 13. Oglesby, R. B.; Black, R. L.; Von Sallmann, L., and Bunim, J. J.: Cataracts in Patients with Rheumatic Diseases Treated with Corticosteroids , Arch. Ophthal. 66:625-630 ( (Nov.) ) 1961.Crossref 14. Paris, J.: Pituitary-Adrenal Suppression after Protracted Administration of Adrenal Cortical Hormones , Proc. Mayo Clin. 36:305-317 ( (June) ) 1961. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Treatment of Pemphigus with Corticosteroids: Results Obtained in 46 Patients Over a Period of 11 Years

Archives of Dermatology , Volume 87 (1) – Jan 1, 1963

Loading next page...
 
/lp/american-medical-association/treatment-of-pemphigus-with-corticosteroids-results-obtained-in-46-KP6kwBdN02

References (14)

Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1963.01590130018006
Publisher site
See Article on Publisher Site

Abstract

Abstract Forty-six patients with pemphigus were placed on treatment with corticosteroids between April, 1950, and October, 1959. Their state was determined as of Oct. 1, 1961. There were 32 patients with pemphigus vulgaris, of whom 21 were living and ambulatory on Oct. 1, 1961. Of the 21 living patients, 5 were free of lesions without treatment; 5 were free of lesions but were still receiving treatment; and 11 had a few lesions and were receiving treatment. Eleven patients had died. At the time of death 5 were free of lesions; 4 had a few lesions; and 2 showed extensive involvement. Of the 11 deaths 3 were attributable and 3 probably attributable to therapy with corticosteroids; while 5 patients had died of unrelated causes. One patient with pemphigus vegetans was free of lesions without treatment. Of the 11 patients with pemphigus foliaceus, 6 were free of lesions and without treatment. Five patients had died, 4 of unrelated causes while free of lesions, and I generalized pemphigus foliaceus while not under our care andnot receiving corticosteroids. Of 2 patients with pemphigus erythematosus one was free of lesions and the other had a few lesions. Neither was receiving any treatment. In pemphigus vulgaris early diagnosis and prompt treatment with high doses of corticosteroids is of great importance. If vigorous and prolonged initial treatment is given, it is more likely that the patient can be carried on small maintenance doses than if the initial treatment is less intensive in amount and duration. After the initial administration of high doses the dosage is reduced in a "logarithmic fashion" to the lowest level adequate for maintenance. During exacerbations large doses of corticosteroids are again required. In contrast to early pemphigus vulgaris, treatment may be withheld in early pemphigus foliaceus so long as the disease remains localized and mild. Side-reactions to the corticosteroids were rather common, especially compression fractures of vertebral bodies, bacterial infections, peptic ulcer, and mental changes. In 2 patients central posterior subcapsular cataracts developed as a result of treatment with large doses of corticosteroids. Concurrent administration of testosterone and estrogens was regarded as effective prophylaxis against vertebral fractures. References 1. One cortisone equivalent is equal to 1 tablet of cortisone (25 mg.); 1 tablet of prednisone (5 mg.); 1 tablet of methyl prednisone (4 mg.); 1 tablet of triamcinolone (4 mg.), and one-half tablet of betamethasone (0.3 mg.). 2. Reznick, L.; Lever, W. F., and Frazier, C. N.: Treatment of Pemphigus with ACTH, Cortisone and Prednisone , New Engl. J. Med. 255:305-315 ( (Aug.) ) 1956.Crossref 3. Sanders, S.; Brodey, M., and Nelson, C. T.: Corticosteroid Treatment of Pemphigus , Arch. Derm. 82:717-724 ( (Nov.) ) 1960.Crossref 4. Stoughton, R. B.: Long-Term Management of Pemphigus Vulgaris with Corticotropin (ACTH) , J.A.M.A. 160:1011-1014 ( (March) ) 1956.Crossref 5. Costello, M. J.; Jaimovitch, L., and Dannenberg, M.: Treatment of Pemphigus with Corticosteroids , J.A.M.A. 165:1249-1255 ( (Nov.) ) 1957.Crossref 6. Stevenson, C. J.: Treatment in Bullous Diseases with Corticosteroid Drugs and Corticotrophin , Brit. J. Derm. 72:11-21 ( (Jan.) ) 1960.Crossref 7. Wittels, W.: Ergebnisse der Kortikosteroidtherapie beim Pemphigus vulgaris , Derm. Wschr. 141:401-410 ( (April) ) 1960. 8. Perry, H. O.: Pemphigus Foliaceus , Arch. Derm. 85:52-69 ( (Jan.) ) 1961.Crossref 9. Linton, W. T. R., and Craig, G. E.: Pemphigus: A Comparison of the Results of Treatment at the Royal Victoria Hospital, Montreal, in the Steroid and Presteroid Eras , Canad. Med. Ass. J. 85:1192-1194 ( (Nov.) ) 1961. 10. Per, M. I., and Mashkilleison, A. L.: Remote Results of Continuous Systemic Corticosteroid Treatment in Pemphigus , Dermatologica 124:99-109, 1962.Crossref 11. Lever, W. F.: Pemphigus , Medicine 32:1-123 ( (Feb.) ) 1953.Crossref 12. Oglesby, R. B.; Black, R. L.; Von Sallmann, L., and Bunim, J. J.: Cataracts in Rheumatoid Arthritis Patients Treated with Corticosteroids , Arch. Ophthal. 66:519-523 ( (Oct.) ) 1961.Crossref 13. Oglesby, R. B.; Black, R. L.; Von Sallmann, L., and Bunim, J. J.: Cataracts in Patients with Rheumatic Diseases Treated with Corticosteroids , Arch. Ophthal. 66:625-630 ( (Nov.) ) 1961.Crossref 14. Paris, J.: Pituitary-Adrenal Suppression after Protracted Administration of Adrenal Cortical Hormones , Proc. Mayo Clin. 36:305-317 ( (June) ) 1961.

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 1963

There are no references for this article.