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Treating pemphigus and pemphigoid can be difficult. Physicians take many factors into consideration when prescribing medication and treatments. Discuss your medical history with your provider to make sure you are given the best possible treamtment for your individual situation.
PrednisonePrednisoneThe corticosteroid prednisone is the drug of choice for treating pemphigus and pemphigoid. Prednisone is a powerful anti-inflammatory that also suppresses the immune system. It is a synthetic form of the naturally occurring steroid hormone cortisone. Prednisone should not be confused with the dangerous anabolic steroids used by athletes to increase muscle mass. Prednisolone, another form of prednisone, is more commonly used outside the United States. Sometimes large doses of prednisone are needed to bring pemphigus or pemphigoid under control. Generally, once the disease has been controlled, the prednisone is gradually reduced or "tapered." Tapering of prednisone is important to reduce the side effects or recurrence of disease activity, but because your own body's ability to make natural cortisone is stopped. Tapering allows your natural process to begin again. Prednisone or prednisolone is generally given as a pill. The initial dose is usually 1 mg/kg (about .5mg/lb) of body weight. The dose may be higher if the disease is severe. Prednisone can also be injected directly into a lesion, or in very mild cases it can be put on lesions in gel or cream form. In some severe cases, large doses of corticosteroids, called "pulse steroids," are administered intravenously in a hospital setting over a period of a few days. Side Effects and Precautions Unfortunately, high doses of prednisone or prolonged prednisone treatment often have undesirable side effects. The seriousness of side effects caused by prednisone generally depends on the amount of and length of time the prednisone is taken. Side effects include weight gain, increased blood pressure, thinning of the bones/osteoporosis, stomach problems, glaucoma, salt retention, steroid-induced diabetes, acne, cataracts, mood changes, and increased susceptibility to infection. Remember, although prednisone can cause all these side effects not all patients will have all of these problems. Living successfully with pemphigus or pemphigoid, therefore, includes making some lifestyle changes in order to manage these side effects. You may also find you will need to take additional medication to control certain side effects. Related Websites http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601102.html ImmunosuppressantsImmunosuppressantsDrugs that suppress the immune system, also called immunosuppressants, are usually used in combination with prednisone. These types of drugs are also used by patients who have had organ or tissue transplants, such as a kidney transplant. They decrease the body's natural defense to foreign bodies, thereby preventing rejection of the transplanted organ by the body. This decrease in the body's own immune system activity makes immunosuppressants useful in the treatment of autoimmune diseases like pemphigus and pemphigoid. When an immunosuppressant is used with prednisone, the dose of prednisone can often be reduced. For this reason, immunosuppressants are often called steroid-sparing drugs. Use of a steroid-sparing immunosuppressant, therefore, can help lower the undesirable side effects of prednisone. The most common immunosuppressants used to treat pemphigus are:
Another sometimes effective immunosuppressant for treating PV is methotrexate. Cyclosporine (Sandimmune®) is also used to treat pemphigus, more frequently outside the United States. Side Effects and Precautions While they can be very effective in the treatment of pemphigus and pemphigoid, immunosuppressants can have serious side effects. These include stomach upset, nausea, vomiting, abdominal pain, darkened urine, pale stools, and jaundice (yellowing of the skin or white portion of the eyes). Another serious side effect is reduced activity of bone marrow. This can be monitored with regular blood tests. Occasionally, patients taking immunosuppressants will develop pancreatitis (inflammation of the pancreas) some months after starting these drugs. Care must be taken when using immunosuppressants. The following are some common-sense suggestions.
Related Websites Azathioprine (Imuran®)
Mycophenolate (MFM or CellCept)
Methotrexate (Rheumatrex®, MTX®)
Cytoxan
Cyclosporine (Sandimmune®, Neoral®) BiologicsBiologicsBiologics are drugs that inhibit inflammatory responses. During a normal immune response, a chemical messenger called tumor necrosis factor, or TNF, attaches to cells throughout the body, causing inflammation. In some cases, the body produces too much TNF, which can lead to uncontrolled inflammation. Rituxan® (Rituximab)Rituxan is a biologic used to treat non-Hodgkin's lymphoma. It may also be effective in treating pemphigus. Given intravenously, it binds to a protein on the surface of B cells (cells that are part of the immune system). This in turn leads to the destruction of these B cells. Since B cells play a role in causing pemphigus blisters, some researchers believe that the destruction of these B cells can reduce or eliminate pemphigus blisters. Possible Side Effects & Interactions Weakness, fatigue, sweating, chills and shaking, headache, breathlessness, racing heart and muscle aches. Related Websites
Remicade® (Infliximab)Remicade is a biologic used to Rheumatoid Arthritis. It is now in clinical trial for pemphigus vulgaris. It is given intravenously and like Enbrel blocks TNF inhibitors. Possible Side Effects & Interactions Weakness, fatigue, sweating, chills and shaking, headache, breathlessness, racing heart and muscle aches. Related Websites
Enbrel® (Eternacept)Enbrel is a biologic used to treat the autoimmune diseases, rheumatoid arthritis and psoriasis. In some cases, the body produces an overactive inflammatory response, like that seen in rheumatoid arthritis and psoriasis. Enbrel deactivates some TNF message before it triggers inflammation. By interrupting the chain of events that leads to inflammation, Enbrel can help reduce inflammatory symptoms. It is now being studied in pemphigus vulgaris patients. Side Effects & Interactions May increase infection risk or decrease blood cell counts when used with other immune modulators or immunosuppressant drugs. Can also cause: Injection site pain; redness, and swelling; fever, rash, cold or flu symptoms; stomach upset; nausea; vomiting. Related Websites IVIgIVIgIntravenous ImmunoGlobulin (IVIG) therapy is prepared from extracting the plasma in human blood. It can take up to 2000 blood donors to make one round of treatment for a patient with pemphigus. Manufacturers make IVIG using several different methods during the manufacturing process to help provide a safe product. Donors are screened for HIV and Hepatitis viruses (B and C) so that patients can be assured that the risk of getting these diseases is reduced. Most products on the market worldwide also go through at least one viral inactivation step in order to kill any remaining active viruses in the unlikely event one is present after the manufacturing process. IVIg is administered intravenously over several hours to reduce the risk of any serious side effects. The course of treatment will depend on the severity of disease. Side Effects & Precautions Potential side effects are headaches, nausea, stomach aches, high blood pressure, and stroke. Related Websites
Other TreatmentsPlasmapheresisA process used that is similar to dialysis. Plasma, blood fluid, is removed from the blood. The plasma is which contains antibodies is discarded and the body is replaced with other fluids. Many pemphigus experts believe that a patient using plamapheresis should be on an immunosuppressive drug to keep from rebounding. Related Websites PhotopheresisPlasma and white-cells are removed from the blood and treated with ultra-violet light. The plasma and white-cells are then returned to the body. Side effects may include nausea and sunlight sensitivity. Related Websites Homeopathy and Other Alternative TherapiesWhile there are some pemphigus/pemphigoid patients who believe that alternative and/or homeopathic treatments have helped them, it should be noted that there have been no studies or medical research with findings indicative of effective treatments or procedures in this area. Other Drug TherapiesDapsoneDapsone® belongs to the family of medicines called anti-infectives. It is used to treat certain skin conditions, including leprosy (Hansen's disease). In certain cases it is used to treat pemphigus. However, most experts would agree that Dapsone®, in most cases, should only be used when a patient is in good control of their disease, and as a steroid-sparing drug with low doses of prednisone. Side Effects & Precautions The most common side-effects of Dapsone® are sore throat, fever, purpura (low platelet count), impaired liver function, anemia, nausea, insomnia, fever, vomiting, abdominal pain, possible psychiatric disorders. If you experience any of the following symptoms, call your doctor immediately: sore throat, fever, rash, yellowing of the skin or eyes, unusual bruising. Related Websites
Gold Salts - Injectable gold salts (Myochrysine, Solganal)The gold compounds are generally used in the treatment of rheumatoid arthritis. They may also be used for other conditions as determined by your doctor. They are not used very much anymore. Side Effects & Precautions Side effects include kidney problems, cutaneous or pulmonary hypersensitivity. Gold stays in the system and may not leave the body once introduced. Hydroxycholroquine (Plaquenil®)Plaquenil® is used to prevent and treat malaria. It also is used in treating certain kinds of liver disease. It can help relieve inflammation, and swelling. There is some evidence that it can be helpful with some patients with pemphigus foliaceus. Side Effects & Precautions Indigestion, which should be helped by taking the medication with food; diarrhea, dizziness, tinnitus (ringing in the ears); skin rashes can occur; eye changes can occur, avoid becoming pregnant. Related Website LukeranThis medicine is an alkylating agent used to treat certain cancers. Tetracycline, Minocycline and DoxycyclineTetracycline, Minocycline (also known as Minocin) or Doxycycline are antibiotics. They are used to fight infections. Some doctors have found that Minocycline may work better than Tetracycline (with Niacinamide) in patients with pemphigus and pemphigoid. These drugs seem to show better results in bullous pemphigoid patients. Side Effects & Precautions Side effects are uncommon, but it can cause upset stomach, diarrhea, dizziness or lightheadedness. It is recommended that one stay out of the sun. Related Websites
NiacinamideNiacinamide is a derivative of Niacin and a water-soluble B Vitamin. It is used to treat Pellagra (a deficiency of Niacin). It is often used in conjunction with one of the cycline drugs to treat pemphigoid and pemphigus. Side Effects & Precautions Itching, nausea, abdominal cramps. May cause hyperglycemia, not recommended for patients with gallbladder disease, jaundice or any other type of liver disease. Related Websites |
