The use of chlorambucil with prednisone in the treatment of pemphigus.
BACKGROUND
Chlorambucil is an alkylating agent that preferentially affects B cells over T cells and has been shown to be effective in the treatment of bullous pemphigoid.


OBJECTIVE
Our purpose was to determine whether chlorambucil is effective in the treatment of pemphigus.


METHODS
We retrospectively reviewed the medical records of 9 patients with pemphigus (7 with pemphigus vulgaris and 2 with pemphigus foliaceus) in whom therapy with other immunosuppressive regimens failed and who were subsequently treated with chlorambucil and prednisone.


RESULTS
There was clinical improvement in 6 of 9 patients and a decrease in indirect immunofluoresent antibody titers in 3 of the 5 patients who had titers drawn before and after treatment with chlorambucil. Three of the 9 patients failed treatment with chlorambucil, as evidenced by lack of improvement of lesions.


CONCLUSIONS
Chlorambucil may be a potential adjuvant therapeutic approach with steroid-sparing effects in patients with pemphigus who have failed treatment with other immunosuppressive regimens.
Shah
N
N
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida 33101, USA.
Green
A R
AR
Elgart
G W
GW
Kerdel
F
F
D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D002699:Chlorambucil / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies
D000477:Alkylating Agents; D005938:Glucocorticoids; D002699:Chlorambucil; D011241:Prednisone