Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.48671
PMID: 19293511

Dexamethasone-cyclophosphamide pulse therapy in pemphigus

Sheikh Manzoor, Yasmeen Bhat, Shabir Ahmad, Andleeb, Inam
 Department of Dermatology, STD and Leprosy, SKIMS Medical College Hospital, Srinagar, India

Correspondence Address:
Yasmeen Bhat
Department of Dermatology, STD and Leprosy, SKIMS Medical College Hospital, Bemina, Srinagar, Jammu and Kashmir
How to cite this article:
Manzoor S, Bhat Y, Ahmad S, A, I. Dexamethasone-cyclophosphamide pulse therapy in pemphigus. Indian J Dermatol Venereol Leprol 2009;75:184-186
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology


Pemphigus vulgaris is a potentially fatal disease in spite of a variety of treatment modalities available. The introduction of dexamethasone-cyclophosphamide pulse (DCP) therapy for the pemphigus group of disorders by Pasricha et al. in 1981 has revolutionized the therapy of pemphigus. [1] The standard DCP therapy had also been given to our patients for the last 5 years and the results are as reported below.

Twenty patients of pemphigus admitted at the SKIMS Medical College Hospital, Srinagar were enrolled for the study prospectively from May 2001 to April 2006. Diagnosis of pemphigus was based on clinical features, Tzanck smear and skin biopsy. Confirmation was carried out by direct immunofluorescence examination. DCP therapy was given to those patients with positive Tzanck smear and histopathological features of pemphigus. Before starting the pulse therapy, investigations undertaken were - complete hemogram, erythrocyte sedimentation rate (ESR), urine analysis, blood sugar, kidney and liver function tests, chest radiography, electro cardiogram and stool examination for occult blood. Two patients had hypertension, one had diabetes and one had associated vitiligo. All investigations were repeated at monthly intervals and when necessary. The patients were monitored for side effects of DCP therapy.

The entire treatment was divided into four phases as per Pasricha et al. schedule. [1]

Phase I: DCP therapy was given in the presence of signs and symptoms. Patients received monthly doses of 100 mg of dexamethasone dissolved in 500 mL of 5% dextrose by slow intravenous infusion over 2 hour on three consecutive days along with 500 mg of cyclophosphamide in the infusion on day 2. In between, the patients received 50 mg of oral cyclophosphamide daily.

Phase II: Patients were in remission but monthly DCP therapy and daily oral cyclophosphamide were continued for 9 months.

Phase III: Only oral cyclophosphamide 50 mg was given to patients for an additional 9 months.

Phase IV: All treatments were withdrawn and patients were followed-up for relapse, if any.

Of the 20 patients of pemphigus vulgaris treated with this regimen, there were nine males and 11 females, the age ranged between 32 and 60 years. One unmarried male and one female who had not completed her family were given dexamethasone pulse (DP) without cyclophosphamide infusion but with daily oral cyclophosphamide. The duration of disease before treatment varied from a minimum of 1 month to a maximum of 7 years. Only six patients were treated with various other modalities before entering the study. Two patients were lost to follow-up. Of the remaining 18 patients, eight are in phase IV, six in phase III and four in phase II. The duration of phase I varied among patients, mostly being 3-4 months, with no correlation with age and sex of patients or the severity of the disease at presentation. Only two patients required daily oral corticosteroids in the first phase and none was given interval pulse. No case of death was seen amongst the cases studied. The duration of continuous remission in the patients is more than 2 years, the maximum being 5 years.

The side effects associated with prolonged treatment with corticosteroids and cyclophosphamide were virtually absent. The common side effects seen were generalized weakness and fatigue (7), gastrointestinal symptoms (5), menstrual irregularities (5), alopecia (4), candidiasis (2), dermatophytosis (1), hypertension (1) and urinary symptoms (1). No significant changes in laboratory parameters were seen.

Pemphigus is an autoimmune bullous dermatosis having a grave prognosis and is associated with high morbidity and mortality. Systemic steroids and other immunosuppressive therapies have remained the mainstay of treatment of pemphigus. [2] DCP therapy designed by Pasricha Gupta for pemphigus and was first used in 1981 with the aim of reducing the toxicity of corticosteroids and also to achieve better therapeutic results. Since then, the same pulse therapy has been used and complete remission of pemphigus has been reported. [3],[4],[5],[6] In addition, the therapy also reportedly leads to a significant decrease in the mortality rate associated with the disease and there is a remarkable decrease in the side effects associated with long-term use of steroids and immunosuppressant drugs. [4],[5],[6],[7] Our study included 20 patients of pemphigus vulgaris, of which eight are already in phase IV and others in different phases also showed remarkable response. The side effects profile was comparable with those from previous studies. [6],[7]

Pasricha JS, Srivastava G. Cure in pemphigus a possibility. Indian J Dermatol Venereol Leprol 1986;52:185-6.
[Google Scholar]
Kerman N. Pemphigus. J Am Acad Dermatol 1988;18:1219-38.
[Google Scholar]
Lever WF, Lever GS. Treatment of pemphigus vulgaris: Results obtained in 84 patients between 1961 and 1982. Arch Dermatol 1984;120:44-7.
[Google Scholar]
Kaur S, Kanwar AJ. Dexamethasone-cyclophosphamide pulse therapy in pemphigus. Int J Dermatol 1990;29:371-4.
[Google Scholar]
Masood Q, Hassan I, Majid I, Khan D, Manzooi S, Qayoom S, et al . Dexamethasone cyclophosphamide pulse therapy in pemphigus: Experience in Kashmir valley. Indian J Dermatol Venereol Leprol 2003;69:97-9.
[Google Scholar]
Thappa DM, Karthikeyan K, Jeevankumar B. Dexamethasone-cyclophosphamide pulse therapy in pemphigus: An appraisal of its outcome in a tertiary health care centre in South India. Indian J Dermatol 2004;49:9-13.
[Google Scholar]
Pandaya AG, Sontheimer RD. Treatment of pemphigus vulgaris with pulse intravenous cyclophosphamide. Arch Dermatol 1992;128:1626-30.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections