A study on effectiveness of dexamethasone-cyclophosphamide pulse therapy, dexamethasone pulse therapy and dexamethasone-methotrexate pulse therapy in cases of pemphigus vulgaris and pemphigus foliaceus

Abstract

Objective To report our 5-year experience in the treatment of pemphigus with dexamethasone-cyclophosphamide pulse therapy, with a slight modification in phase I which resulted in higher rates of remission and no relapses. Methods All patients diagnosed as pemphigus on the basis of clinical and histopathological grounds were started on DCP therapy, but patients in the reproductive age group, both unmarried and those who had not completed their families were started on dexamethasone pulse therapy and Dexamethasone methotrexate pulse therapy was considered in patients with prolonged phase I (>9cycles). Results A total of 51 cases diagnosed with pemphigus were included in the study, of which 21 were males and 30 were females. 49 cases were of Pemphigus vulgaris type and 2 cases were of Pemphigus foliaceus. DCP therapy was started on 46 patients and dexamethasone pulse therapy was started in 5 females of reproductive age group who were yet to complete their families. 2 patients with prolonged phase I (>9cycles) were shifted to dexamethasone methotrexate pulse therapy, of which one patient was initially on dexamethasone pulse therapy, who was unmarried and methotrexate was started after taking informed consent. 9 patients discontinued the treatment in phase I after around 3-4cycles and 7 patients were lost for follow up during phase II. The average duration of phase I was 6 months. At present, 13 patients are in phase I and a total of 6 patients in phase II, 7 patients in phase III and 9 patients in phase IV are in complete clinical remission, with absolutely no relapses in compliant patients except for defaulters. Conclusion Phase I was continued not only until the new lesions stopped appearing, but was extended for 3 more months even after the new lesions ceased, to appear to reduce the relapse rates when the patient enters phase II.