dermatologic disorders
Pemphigus Vulgaris
Treatment of Pemphigus Vulgaris
Corticosteroids, oral or IV Sometimes immunosuppressants Sometimes plasma exchange or IV immune globulin (IVIG) Referral to a dermatologist with expertise in treating this disorder is recommended. Hospitalization is required initially for all but the most minor cases. Cleansing and dressing of open skin lesions is similar to that done to Initial wound care (eg, reverse isolation, hydrocolloid or Treatment of pemphigus vulgaris is aimed at decreasing production of pathogenic autoantibodies. The mainstay of treatment is systemic corticosteroids. Some patients with few lesions may respond to oralprednisone20 to 30 mg once a day, but most require 1 mg/kg once a day as an initial dose. Some clinicians begin with even higher doses, which may slightly hasten initial response but do not appear to improve outcome. If new lesions continue to appear after 5 to 7 days, IV pulse therapy withmethylprednisolone1 g once a day can be tried. Once no new lesions have appeared for 7 to 10 days, corticosteroid dose should be tapered monthly by about 10 mg/day (tapering continues more slowly once 20 mg/day is reached). A relapse requires a return to the starting dose. If the patient has been stable after a year, a trial without treatment can be attempted but must be closely monitored. ( Treatment references ), 1.Craythorne EE, Mufti G, DuVivier AW:Rituximabused as a first-line single agent in the treatment of pemphigus vulgaris.J Am Acad Dermatol65(5):1064–1065, 2011. doi: 10.1016/j.jaad.2010.06.033 2.Joly P, Maho-Vaillant M, Prost-Squarcioni C, et al: First-linerituximabcombined with short-termprednisoneversusprednisonealone for the treatment of pemphigus (Ritux 3): A prospective, multicentre, parallel-group, open-label randomised trial.Lancet389(10083):2031–2040, 2017. doi: 10.1016/S0140-6736(17)30070-3 