Response by the author
Department of Skin & STD, Kasturba Medical College, Manipal - 576119
|How to cite this article:
Balachandran C. Response by the author . Indian J Dermatol Venereol Leprol 2003;69:314-315
I appreciate the keen interest shown by Dr. Ramji Gupta in our article ′Treatment of pemphigus′.
1. I agree that there are only 25 references. Reference number 4 in the text should be 3, reference number 5 should be 4 and so on. I regret this error.
2. Regarding the second question, I have not made any such comment in the text.
I would like to mention that the current dexamethasone-cyclophosphamide pulse regimen is not final and needs modifications. There are now various centers in India using it, but there is no uniformity. With our vast experience in pulse therapy, we should evolve a modified uniform regimen.
3. It is better to give a slow infusion for 3-4 hours, as there is a risk of cardiac toxicity with rapid steroid infusion.
4. We have been following this regimen for many years now. We have had two deaths due to septicemia in phase 1 in spite of the patient being on antibiotics. Hence, infection is an important complication that should be appropriately treated.
The majority of patients respond within 4 pulses in the first stage and require about 6 pulses in the second stage. We also had patients who required about 24 pulses for remission. A few patients also had relapsed during the third phase. But overall this is an acceptable treatment modality.
5. I did not add many Indian references regarding pulse therapy as there were no new messages to convey.