Dexamethasone-Cyclophosphamide Pulse Therapy In Pemphigus : An Appraisal OF Its Outcome In A Tertiary Health Care Center In South India

Abstract

Dexamethasone-cyclophoshamide pulse (DCP) therapy, designed by Pasricha and Gupta for pemphigus was first used in 1981 with the aim of reducing the toxicity of corticosteroids and also to achieve better therapeutic results. We have been using the same pulse therapy and herewith are presenting the results of pulse therapy in pemphigus were included in the study over a period of 6 years. They consisted of 51 cases of pemphigus vulgaris and 4 cases of pemphigus foliaceous. The male to female ration was 1.2:1. The age distribution showed a bimodal pattern with peaks at 21-30 years and 51-60 years. The body surface area involved at the time of initiation of DCP was less than 25% in 25, 25-50% in 19 and more than 50% in 11 cases. Oral cavity was involved in all cases of pemphigus vulgaris and eyes were affected in 4 patients. Twentysix cases were managed with DCP pulses only and were in remission in phase II and three of our patients in remission in phase III relapsed at 6 to 9 months. Interpulse steroids were required to induce remission in 11 patients. The remaining 18 patients did not proceed to phase II as they was either defaulting or had active disease. Only four cases progressed into phase IV and were declared cured. The various complications seen in our patients were candidiasis (n=5), hiccups (2), acneiform eruption (2), iatrogenic Cushing’s syndrome (1), herpes zoster (1), striae distensae (1), umbilical abscess (1), alopecia (1), azoospermia (1) pneumonia (1) and deep vein thrombosis (1). Two Patients on pulse therapy died of septicemia.