Treatment of Pemphigus Vulgaris and Pemphigus Foliaceus: Experience with 30 Patients

Abstract

Pemphigus vulgaris and Pemphigus foliaceus are chronic, painful diseases which treatment causes great impact. This study focuses on the age, gender, mucosal lesions, therapy with oral prednisone, clinical remission rates and side effects. Material And Methods : Six males/15 females with Pemphigus vulgaris and three males/six females with non-endemic pemphigus foliaceus attended at Hospital Universitario from 2003 to 2018 were submitted to histopathology through skin or mucosa biopsy. Oral prednisone (monotherapy) in seven Pemphigus vulgaris and two pemphigus foliaceus; in case of no control or relapses, association with cyclophosphamide pulse therapy (12PV/4PF), dexamethasone pulse therapy (ten PV/two PF), hydroxychloroquine (three PV/four PF), azathioprine (five PV),methotrexate (four PV/one PF), immunoglobulin cycles (two PV/two PF). Results : Mostly patients were female aged 30-59 years old; oral mucosal lesions in 19 (90,4%) pemphigus vulgaris. After a ten year period of monitoring it was observed in the group of monotherapy: one PV/one PF achieved complete remission on low dose of prednisone; two PV achieved partial remission on low dose and four PV/one PF on high dose. In the group with combined drugs, four PV were off prednisone, four PV/one PF achieved complete remission on low dose and two PF on high dose; two PV/three PF achieved partial remission on low dose and four PV/one PF on high dose. The most common side effects of prednisone were mucocutaneous candidiasis, arterial hypertension, subcapsular posterior cataracts, bacterial and viral infections and diabetes mellitus. Conclusion : Both diseases ran a chronic and unpredictable course which management was extremely difficult. Females with pemphigus vulgaris developed severe multiple mucosal lesions.