Abstract Alternate-day prednisone, in a starting oral dose of 160 mg every other morning, has effectively controlled previously untreated mild to moderately severe pemphigus vulgaris (PV) in three patients. Titers of pemphigus-type, intercellular antibodies decreased during treatment and roughly paralleled clinical improvement. The lack of serious side effects, normal pituitary-adrenal function, and intact delayed hypersensitivity responses with this treatment schedule suggest that there are definite advantages over conventional daily, divided-dose corticoid regimens. This type of alternate-day prednisone regimen in adequate doses also has been effective in controlling a second group of patients with PV who had been treated previously with prednisone in two or four doses daily. Further experience with alternate-day prednisone therapy is needed in order to determine whether such a schedule could be the treatment of choice in mild and moderately severe PV. References 1. Costello MJ, Jaimovich L, Dannenberg M: Treatment of pemphigus with corticosteroids . JAMA 165:1249-1255, 1957.Crossref 2. Sanders SL, Brody M, Nelson CT: Corticosteroid treatment of pemphigus . Arch Derm Syph 82:717-724, 1960.Crossref 3. Lever WF, White H: Treatment of pemphigus with corticosteroids: Results obtained in 46 patients over a period of 11 years . Arch Derm 87:12-26, 1963.Crossref 4. Harter JG, Reddy WJ, Thorn GW: Studies on an intermittent corticosteroid dosage regimen . New Eng J Med 269:591-596, 1963.Crossref 5. MacGregor RR, Sheagren JN, Lipsett MB, et al: Alternate-day prednisone therapy: Evaluation of delayed hypersensitivity responses, control of diseases, and steroid side effects . New Eng J Med 280:1427-1431, 1969.Crossref 6. Ackerman GL: Alternate-day steroid therapy in lupus nephritis . Ann Intern Med 72:511-519, 1970.Crossref 7. Beutner EH, Jordon RE: Demonstration of skin antibodies in sera of pemphigus vulgaris patients by indirect immunofluorescent staining . Proc Soc Exp Biol Med 117:505-510, 1964.Crossref 8. Rabhan NB: Pituitary-adrenal suppression and Cushing's syndrome after intermittent dexamethasone therapy . Ann Intern Med 69:1141-1148, 1968.Crossref 9. Silber RH, Porter CC: The determination of 17, 21-dihydroxy-20-ketosteroids in urine and plasma . J Biol Chem 210:923-932, 1955. 10. Waldorf DS, Sheagren JN, Trautman JR, et al: Impaired delayed hypersensitivity in patients with lepromatous leprosy . Lancet 2:733-776, 1966. 11. Dougherty TF, Brown HE, Berliner DL: Metabolism of hydrocortisone during inflammation . Endocrinology 62:455-462, 1958.Crossref 12. Nichols T, Nugent CA, Tyler FH: Diurnal variation in suppression of adrenal function by glucocorticoids . J Clin Endocr 25:343-349, 1965.Crossref 13. DiRaimondo VC, Forsham, PH: Pharmacophysiologic principles in the use of corticoids and adrenocorticotropin . Metabolism 7:5-24, 1958. 14. Soyka LF: Treatment of the nephrotic syndrome in children: Use of an altemate-day prednisone regimen . Amer J Dis Child 113:693-701, 1967.Crossref 15. Reichling GH, Kligman AM: Alternate-day corticosteroid therapy . Arch Derm 83:980-983, 1961.Crossref 16. Epstein WL, DiRaimondo VC: Measurement of cutaneous anti-inflammatory activity of ACTH and corticoids in man . J Invest Derm 35:361-366, 1960.Crossref 17. Bird DC, Sheagren JN: Effect of an alternate-day and daily schedule of corticosteroid administration on reticulo-endothelial system (RES) phagocytic function and response to infection with Candida albicans , abstracted. Clin Res 17:363, 1969.
Archives of Dermatology – American Medical Association
Published: Jun 1, 1971