Treatment of pemphigus: a local experience

A clinical study was conducted to evaluate the efficacy and safety of three currently used treatment modalities for pemphigus. Seventy-two patients of pemphigus (pemphigus vulgaris and severe cases of pemphigus vegetans, pemphigus foliaceous and pemphigus erythematosus) were divided into three groups. Forty patients were treated with prednisolone, 15 with a combination of prednisolone plus azathioprine and 17 patients with betamethasone-cyclophosphamide pulse (BCP) therapy. All patients were followed from 9 to 21 months (mean 16 months). There was no statistical difference between steroid and azathioprine-corticosteroid therapy groups in terms of time taken to achieve initial control of the disease but the frequency of relapses and the incidence of complications were higher in patients treated with corticosteroids alone (p < 0.05). A marginally increased susceptibility to infections was seen in patients treated with BCP therapy as compared with azathioprine-corticosteroid group (p = 0.07). Seventy percent patients treated with BCP therapy required additional steroids in between the monthly pulses, indicating failure of BCP as sole therapy. It was concluded that azathioprine-corticosteroid treatment of pemphigus was more effective and comparatively safer than steroid alone or BCP therapy.