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Suggeest treatment for pemphigus vulgaris

Jan 2014
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Practicing since : 2002
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My mother is suffering with pemphigus vulgaris for the past 3 years and we visited all the doctors and still suffering, could you please suggest some good doctor , few doctors suggested to take pulse treatment for 18 months but after taking pulse her condition is getting worst and she is getting sever gastric problem so we stopped it. she is using omnacortil and Aziron , any side effects with the pulse or with medicine. how to cure this .Please suggest some alternate treatment .
Posted Thu, 13 Mar 2014 in Skin Rash
Answered by Dr. Kakkar S. 37 minutes later
Brief Answer: Pemphigus vulgaris Detailed Answer: Hi. Thanks for posting your concern at HCM. Pemphigus vulgaris is an autoimmune blistering disease characterised by flaccid intraepidermal bullae, which rupture easily and leave behind painful erosions. The erosions can involve the scalp, oral mucosa, lips, trunk and abdomen, groin and genitals. Your mother has been on Omancortil, which is an oral steroid whereas Aziron is Azithromycin, an oral antibiotic. Pulse Therapy: Pulse therapy for pemphigus offers the only chance of long term cure/remission and is considered to be relatively safe and side effects are minor and few as compared to daily oral steroids. The common side effects are generalized weakness and fatigue, gastrointestinal symptoms, menstrual irregularities, alopecia, candidiasis, dermatophytosis, hypertension and urinary symptoms. Management options for pemphigus vulgaris: Topical and systemic treatment Topical: -Topical steroids -Topical antibiotics Systemic: -Oral steroids -Oral antibiotics like tetracycline and erythromycin -Cyclophosphamide -Mycophenolate Mofetil -Azathioprine -Methotrexate Since daily oral steroids have a lot of adverse effects like weight gain, weakening of the bones (osteoporosis), diabetes, high blood pressure, glaucoma, cataracts etc they should not be continued alone forever, but instead patients should be simultaneously started on various other safer but slow acting options (steroid sparing agents) like cyclophosphamide, Mycophenolate Mofetil, Azathioprine, OR Methotrexate. Steroids can be tapered gradually and finally stopped once the steroids sparing agents take full control of the disease. Pulse therapy therefore has many advantages over daily oral steroids besides offering the only realistic chance of cure or long term remission. It can be administered only in an hospital setting and usually is available in a medical college associated hospital/research hospital. take care regards
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Follow-up: Suggeest treatment for pemphigus vulgaris 44 hours later
Thank you sir, I have few questions. could you please explain me about (steroid sparing agents) how to continue this . we are looking for a treatment apart from steroids and pulse. if she takes pulse the condition is getting worse. please suggest . we heard that there are some injections ( cost around 16 to 20 k) please provide me details about this . also please suggest some good doctor or hospital to take the treatment.
Answered by Dr. Kakkar S. 19 minutes later
Brief Answer: Pemphigus vulgaris Detailed Answer: Hi. 'Steroid sparing agents' as the name indicates are intended to spare the patients from steroids related side effects. Steroid sparing agents are slower acting as compared to steroids and are therefore started together with oral steroids OR intravenous steroids but after 4-6 weeks once they take full control, steroids can then be tapered and ultimately stopped, whereas the Steroid sparing agents are continued. Thus they have a steroid sparing effect. Over the years, advances have been made to expand our therapeutic armamentarium for pemphigus. Emerging therapies include intravenous immunoglobulin (IVIg), plasmapheresis, immunoadsorption (IA), rituximab, tumor necrosis factor-alpha (TNF-alpha) antagonists (infliximab and etanercept), cholinergic agonists etc. They are expensive and not commonly used as yet. Probably the injection you are mentioning about is IVIg which is expensive. I would advice that you get her admitted in any one of the medical college associated hospitals (like e.g AIIMS or Safdurjung hospital in delhi, ). Since you stay in Hyderabad, so you can get her admitted to a medical college associated hospital in Hyderabad. Treatment is expensive and she might require long term therapy and follow up and therefore it is better to get her admitted to a government hospital or a semi-government hospital, which is attached to a medical college/ teaching college and therefore will be well taken care of. take care regards
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