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Abstract:
Over the past ten to fifteen years cytotoxic drugs have gradually been added to the therapeutic armamentarium of physicians other than oncologists, particularly dermatologists. They are being used to treat nonmalignant cutaneous diseases such as pemphigus vulgaris, bullous pemphigoid, and psoriasis. The rationale for their use in these diseases is conjectural, yet those dermatologists who use them feel strongly not only that cytotoxic drugs are effective, but that when used properly, they are relatively safe. The immunosuppressive activity of cytotoxic drugs has been accepted and widely acclaimed in immunology, renology, and transplant medicine. However, their usefulness in two autoimmune diseases frequently managed by dermatologists is widely disputed. In this short discussion the rationale for the use of cytotoxic agents and evidence for their effectiveness when used appropriately in progressive systemic sclerosis and systemic lupus erythematosus is presented.