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Therapy of autoimmune bullous diseases.

Mutasim DF - Ther Clin Risk Manag (2007)

Bottom Line: Bullous diseases are associated with a high degree of morbidity and occasional mortality.The therapeutic agents used in the treatment of bullous diseases may be associated with high morbidity and occasional mortality.Successful treatment requires understanding of the pathophysiology of the disease process and the pharmacology of the drugs being used.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Cincinnati College of Medicine Cincinnati, OH, USA.

ABSTRACT
Autoimmune bullous diseases result from an immune response to molecular components of the desmosome or basement membrane. Bullous diseases are associated with a high degree of morbidity and occasional mortality. Therapy of bullous diseases consists of suppressing the immune system, controlling inflammation and improving healing of erosions. The therapeutic agents used in the treatment of bullous diseases may be associated with high morbidity and occasional mortality. Successful treatment requires understanding of the pathophysiology of the disease process and the pharmacology of the drugs being used.

No MeSH data available.


Related in: MedlinePlus

Algorithmic approach to the treatment of bullous pemphigoid.Abbreviations: IVIg, intravenous immunoglobulin.
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fig2: Algorithmic approach to the treatment of bullous pemphigoid.Abbreviations: IVIg, intravenous immunoglobulin.

Mentions: Tetracyclines (or erythromycin) with or without niacinamide (Berk and Lorincz 1986; Thomas et al 1993) has been used effectively in BP. In one study, the effectiveness of tetracycline and niacinamide was compared with that of prednisone in the treatment of generalized BP (Fivenson et al 1994). The two therapeutic regimens were equally effective. The dose of tetracycline was 500 mg four times daily. It could be replaced with minocycline or doxycycline 100 mg twice daily. The dose of niacinamide is 500 mg three times daily. The use of a tetracycline with niacinamide may be indicated as sole therapy for very limited disease or as steroid-sparing in patients requiring adjuvant therapy. A recent report attempted to determine the evidence for treating BP from six randomized control trials that included 293 patients (Khumalo et al 2002). The authors could not derive any strong recommendations from the available evidence. An attempt at creating guidelines for treating BP have been reported (Khumalo et al 2002; Mutasim 2002; Wojnarowska et al 2002). Systemic glucocorticoids are the best established treatment. Consideration should be given to potent topical steroids for localized disease. For mild to moderate disease, a tetracycline and niacinamide may be considered. It is recommended that immunosuppressive agents be used only if glucocorticoid cannot be tapered to an acceptable level. The best established drug is azathioprine followed by methotrexate (Khumalo et al 2002). Figure 2 is a proposed algorithm for the treatment of BP.


Therapy of autoimmune bullous diseases.

Mutasim DF - Ther Clin Risk Manag (2007)

Algorithmic approach to the treatment of bullous pemphigoid.Abbreviations: IVIg, intravenous immunoglobulin.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1936286&req=5

fig2: Algorithmic approach to the treatment of bullous pemphigoid.Abbreviations: IVIg, intravenous immunoglobulin.
Mentions: Tetracyclines (or erythromycin) with or without niacinamide (Berk and Lorincz 1986; Thomas et al 1993) has been used effectively in BP. In one study, the effectiveness of tetracycline and niacinamide was compared with that of prednisone in the treatment of generalized BP (Fivenson et al 1994). The two therapeutic regimens were equally effective. The dose of tetracycline was 500 mg four times daily. It could be replaced with minocycline or doxycycline 100 mg twice daily. The dose of niacinamide is 500 mg three times daily. The use of a tetracycline with niacinamide may be indicated as sole therapy for very limited disease or as steroid-sparing in patients requiring adjuvant therapy. A recent report attempted to determine the evidence for treating BP from six randomized control trials that included 293 patients (Khumalo et al 2002). The authors could not derive any strong recommendations from the available evidence. An attempt at creating guidelines for treating BP have been reported (Khumalo et al 2002; Mutasim 2002; Wojnarowska et al 2002). Systemic glucocorticoids are the best established treatment. Consideration should be given to potent topical steroids for localized disease. For mild to moderate disease, a tetracycline and niacinamide may be considered. It is recommended that immunosuppressive agents be used only if glucocorticoid cannot be tapered to an acceptable level. The best established drug is azathioprine followed by methotrexate (Khumalo et al 2002). Figure 2 is a proposed algorithm for the treatment of BP.

Bottom Line: Bullous diseases are associated with a high degree of morbidity and occasional mortality.The therapeutic agents used in the treatment of bullous diseases may be associated with high morbidity and occasional mortality.Successful treatment requires understanding of the pathophysiology of the disease process and the pharmacology of the drugs being used.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Cincinnati College of Medicine Cincinnati, OH, USA.

ABSTRACT
Autoimmune bullous diseases result from an immune response to molecular components of the desmosome or basement membrane. Bullous diseases are associated with a high degree of morbidity and occasional mortality. Therapy of bullous diseases consists of suppressing the immune system, controlling inflammation and improving healing of erosions. The therapeutic agents used in the treatment of bullous diseases may be associated with high morbidity and occasional mortality. Successful treatment requires understanding of the pathophysiology of the disease process and the pharmacology of the drugs being used.

No MeSH data available.


Related in: MedlinePlus