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3.
Artigo em Inglês | MEDLINE | ID: mdl-18583786

RESUMO

BACKGROUND: If administered properly, dexamethasone cyclophosphamide pulse (DCP) therapy has the potential to effect lifelong recovery from pemphigus. AIMS: The objective of this paper is to highlight various parameters of DCP therapy and also, to report the effects of a few modifications in the regimen. METHODS: An analysis of 123 patients treated with the DCP/DP regimen over a period of five years (1998 to 2002) is presented here. Seventeen patients who did not start/continue the treatment and three patients who died during the treatment have been excluded from the analysis. Twenty patients who had not yet started families were given only dexamethasone pulses (DPs) while 103 patients received DCPs. Low dose (50 mg/day) cyclophosphamide was used as in the standard regimen. The three modifications introduced into the regimen were: (1) an additional daily dose of oral betamethasone sufficient to control the disease activity during phase I, which was progressively tapered off completely as the patient recovered, (2) use of systemic antibiotics if the patient had skin lesions, and oral anti-candida drugs if the patient had oral ulcers until complete healing, and (3) insistence on thorough cleaning of the skin and scalp with a normal soap and shampoo, and proper maintenance of oral hygiene in spite of skin/mucosal lesions. The regimen consisted of DCP/DP repeated in exactly 28-day cycles, along with 50 mg cyclophosphamide per day, insistence on completing the treatment and avoiding irregular pulses in all patients. The number of DCPs/DPs during phase I varied in different patients depending upon the dose of betamethasone used and the rate of recovery, but phase II (nine DCPs/DPs in exactly 28-day cycles along with 50 mg cyclophosphamide per day) and phase III (only 50 mg cyclophosphamide per day) was fixed at nine months each. This was followed by posttreatment follow-up (phase IV). RESULTS: At present, all the patients are in complete remission. The confirmed period of posttreatment, disease-free follow-up period has already been more than five years in 62 patients, 3-5 years in 41 patients, 2-3 years in three patients and less than two years in six patients. Eight DCP patients and three DP patients developed a relapse (the relapse rates thus being 7.7 and 15% respectively) and received a second course of pulse therapy. They are also in remission at present. The duration of phase I was three months in 62 patients, 4-5 months in 28 patients, 6-9 months in 13, 10-12 months in nine patients and more than 12 months in 11 patients. The maximum daily dose of betamethasone used in these patients was nil in 17 patients, 1-2 mg in 85, 3-4 mg in 16, and> 4 mg in five patients. CONCLUSIONS: The modifications employed in this study could ensure the cure of all pemphigus patients by using DCP therapy administered at a private clinic.


Assuntos
Betametasona/administração & dosagem , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Imunossupressores/administração & dosagem , Pênfigo/tratamento farmacológico , Adolescente , Adulto , Idoso , Amenorreia/induzido quimicamente , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Azoospermia/induzido quimicamente , Betametasona/efeitos adversos , Ciclofosfamida/efeitos adversos , Dexametasona/efeitos adversos , Vias de Administração de Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Higiene , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pênfigo/imunologia , Pulsoterapia , Recidiva , Indução de Remissão , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-17642929
5.
Artigo em Inglês | MEDLINE | ID: mdl-17656887

RESUMO

H, antihistamines relieve urticaria by blocking the action of histamine on the target tissue, while demonstration of autoantibodies in the sera of a proportion of the patients having chronic idiopathic urticaria, use of immunosuppressive drugs for the treatment of these patients has acquired the greater rationality. We evaluated the role of corticosteroids and cyclophosphamide in the treatment of chronic dermographic urticaria. Twenty-five patients, 13 males and 12 females, between 18-53 years in age, having chronic dermographic urticaria were taken up for this study. The patients were divided into three groups. Group I patients (n=9) were treated with cetirizine hydrochloride 10 mg per day orally, group II patients (n=7) were treated with betamethasone 2 mg along with cyclophosphamide 50 mg along with cetirizine 10 mg per day for a total period of 4 weeks. The patients were evaluated every week to record the therapeutic response and side effects, and then followed up without treatment for a period of 6 months to look for recurrence of the urticaria, if any. Six patients in group I and all the patients in group II and group III had complete remission while the remaining patients in group I had partial relief. The side effects included drowsiness in 4 patients. All the patients in group II had weight gain, 4 patients had acne and 2 patients developed cushingoid features. Majority of the patients relapsed within 3 days after stopping the treatment. Supplementation of the treatment with oral corticosteroids or cyclophosphamide was more effective in controlling the symptoms as compared to cetirizine alone. But a four weeks supplementation was not adequate for preventing the relapses when the drugs were withdrawn.

6.
Artigo em Inglês | MEDLINE | ID: mdl-17656910

RESUMO

In an open clinical study, efficacy of 5% aqueous solution of lactate for preventing acne was evaluated in 22 patients. Lactate lotion was used topically all over the face twice a day and continued like a cosmetic for 1 year. Systematic antibiotics were given for periods of 4 weeks whenever the disease was severe. The effect of the treatment was evaluated by counting the number of comedones, inflammatory lesions and cysts separately once a month and recording them graphically. The greatest reduction in the lesion counts was achieved in 8-24 weeks for the inflammatory lesions and 8-30 weeks for the comedones. At the end of 1 year 90-100% reduction of the inflammatory lesions was achieved in 40.9% patients and non-inflammatory lesions in 22.7% patients. The remaining patients showed 50-90% reduction, while 2 patients showed less than 50% reduction in the non-inflammatory lesions. Thus, most of the patients showed significant reduction in the lesion counts. Aggravations were associated with the hot and the rainy season and required concomitant treatment with oral antibiotics.

7.
Artigo em Inglês | MEDLINE | ID: mdl-20877047
8.
Artigo em Inglês | MEDLINE | ID: mdl-20877053

RESUMO

Twelve patients, 9 males and 3 females between 22 to 65 years in age having air-borne contact dermatitis (ABCD) for 6 months to 12 years were included in this study. The diagnosis in each patient was confirmed by patch tests. Six of these patients (group I) were treated with pentoxifylline 400 mg three times a day orally in addition to topical clobetasol propionate and oral betamethasone 1.0 to 2.0 mg per day for 5 to 10 weeks. The other 6 patients (group II) were given the same treatment for the same duration but without pentoxifylline. The response to the treatment in both the groups was almost the same. The patients treated with pentoxifylline did not have any added benefit. There were no significant side effects of the therapy in either of the groups.

9.
Artigo em Inglês | MEDLINE | ID: mdl-20885046

RESUMO

Freckles are fairly common and considered to be incurable. We have developed a new technique called "Chemo-inflammation" with which we have treated 5 patients (4 girls and one boy) having extensive freckles with excellent results. All the freckles disappeared completely from the treated areas and there has been no recurrence so far. The technique consists of applying a liquid based on an alkyl sulphate, on the affected skin and repeating the application every hour for a day till the entire skin develops adequate inflammation. The liquid is then washed off with tap water and the skin is treated with topical (or systemic) corticosteroids till the inflammation subsides and the treated skin peels off and attains its normal texture. This generally happens within a week or so. Post-inflammatory hyperpigmemation has to be prevented by adequate anti-inflammatory treatment. Otherwise there are no precautions.

10.
Artigo em Inglês | MEDLINE | ID: mdl-20947962

RESUMO

Two patients having air-borne contact dermatitis (ABCD) caused by Parthenium hysterophorus.for 10 and 15 years respectively and without having had complete remissions in spite of oral betamethasone in a dose of 2-3 mg per day, experienced complete relief while taking 50-100 mg azathioprine for 5 and 12 weeks without having to take systemic corticosteroids. There were no side effects of azathioprine. With further experience and standardization of the treatment schedule, it may be possible to use azathioprine as a corticosteroid-sparing agent to reduce the side effects of corticosteroids in patients having ABCD.

11.
Artigo em Inglês | MEDLINE | ID: mdl-20947995

RESUMO

An 8-year-old girl having alopecia areata which progressed to alopecia totalis in 1½ years showed an incomplete regrowth of the hair when treated with our standard regime of 1 mg betamethasone per day orally in spite of the treatment having been continued for 8 months. She had also increased her body weight by 4 kg during this period. On instituting the OMP regime consisting of 5 mg betamethasone as a single oral dose with breakfast on two consecutive days per week, she showed complete regrowth of the hair over the entire scalp during the next 3 months, and there were no side effects. We recommend OMP as another choice for patients having alopecia areata especially in recalcitrant cases where the treatment has to be given for prolonged periods.

12.
Artigo em Inglês | MEDLINE | ID: mdl-20948067

RESUMO

Hypotrichosis present at birth occurring as an isolated defect in three members of an Afghan family and transmitted as an autosomal dominant trait, responded to topical applications of fluocinolone acetonide acetate ointment. The patients were a 9-year-old boy, his 7-year-old sister and their 30-year-old mother who since birth, had sparse, light-coloured and thin hairs on their scalp which would not grow longer than 1 cm in length. Microscopic examination revealed the hairs to be thin and fragile, but of a uniform thickness. Some of the hairs showed secondary trichorrhexis. Following topical applications of 0.1% fluocinolone ointment, the hairs became coarser and increased in length from an ayerage of 0.7 cm before treatment to 6.2 and 7.1 cm in the two children after 10 months. The mother who started the treatment later also showed improvement.

13.
Artigo em Inglês | MEDLINE | ID: mdl-20953020

RESUMO

Most cases having air-borne contact dermatitis (ABCD) in India are considered to be caused by Parthenium hysterophorus. In some cases however, other plants have also been noticed to give positive patch test reactions. We are reporting two cases presenting as ABCD who showed positive patch tests with Xanthium strumarium while the patch tests with Parthenium hysterophorus were negative. It is therefore necessary to realise that every case of ABCD is not caused by Parthenium, and patch testing with Parthenium alone can lead to serious mistakes.

14.
Artigo em Inglês | MEDLINE | ID: mdl-20953034

RESUMO

A 22-year-old boy having two attacks of urticaria per day for the last 5 years and intermittent attacks of sneezing and rhinorrhoea, and without any clues to the causative agent in spite of a detailed history and follow up, showed almost complete relief on wearing an ordinary cloth mask for 3 days. He was subsequently trained to use the soft nasal filters and obtained almost 80% relief in urticaria and complete relief in rhinitis during the next 1 year. Wearing the mask for 2 days again led to complete relief and further training in the proper use of the filters was helpful.

15.
Artigo em Inglês | MEDLINE | ID: mdl-28112107

RESUMO

Response of vitiligo patients to five different regimes was evaluated taking only those patients who had either static or progressively increasing lesions. Selection of the regimen depended upon the clinical characteristics of the disease. Each regime was tried for at least 4 months and if a patient didnot improve with one regime, he was shifted to another regime. A patient was considered to have improved, if the lesions started regimenting or the previously progressive lesions stopped increasing further. Regime I consisted of 150 mg levamisol orally on two consecutive days per week, given to 13 cases, it resulted in improvement in 7 (53.80/o). Regime II consisted of levamisole in the same dose combined with once a day topical massage with 0.1% fluocinolone acetonide acetate cream; it led to improvement in 27 (81.8%) of the 33 cases. Regime III consisted of 3 mg betamethasone orally on alternate days combined with levamisole and topical fluocinolone; given to 32 cases, it was successful in 28 (87.50/o). A combination of 2 mg betamethasone orally alternating with 20 mg 8-methoxypsoralen and sun exposure (regime IV) caused improvement in 17 (85%) of the 20 cases. An oral mini pulse consisting of 5 mg betamethasone orally twice a week combined with 50 mg cyclophosphimide daily orally (regime V) was successful in 20 (90.9%) of the 22 cases, the remaining two cases showed unprovement when the dose ofbetamethasonc .was increased from 5 mg to 7.5 mg twice a week. Thus ultimately each one of the 91 patients responded to one or the other regime. The side effects were minimal and insignificant.The degree of improvement at the time of analysis was 100% in 23.3% cases, 50-100% in 44.2'Yo cases and less than 50% in 32.5%, after 4-14 months of treatment. It is felt that the results may be better after a longer follow-up although all patients are not expected to get complete repigmentation.

16.
Artigo em Inglês | MEDLINE | ID: mdl-28112113

RESUMO

Scanning electron microscopy of the terminal part of hair taken from Indian girls who complained of terminal splitting of their hair, shortening of the hair lengths and loss of small fragments of hair, revealed longitudinal splitting of the terminal part of the hair into two fragments characteristic of trichoptilosis. In addition these hair had a localized spot a few millimeters proximal to the distal end of the hair which revealed splintering of the hair shaft into multiple fragments which joined again at a lower level. These changes are characteristic of trichorrhexis nodosa and this is considered to be responsible for the breakage and loss of small fragments of hair.

17.
Artigo em Inglês | MEDLINE | ID: mdl-28128101

RESUMO

Our regime for the treatment of pemphigus consists of 100mg dexamethasone dissolved in 5% glucose given by a slow intravenous drip over 1-2 hours and repeated on 3 consecutive days. On the first day, 500 mg cyclophosphamide is also given in the same drip. Such dexamethasone cyclophosphamide pulses (DCP) are repeated once a month. In between the (DCP), the patient is given only 50 mg cyclophosphamide daily orally. During the first few methods of starting this treatment, most patients continue to get relapses of pemphigus lesions in between the DCP (phase I). After a variable period however, almost all patients stop having such relapses, but we continue to give once monthly DCP for atleast 6 months (phase II), After which the DCP is stopped and the patient continues to take 50 mg cyclophosphamide daily orally for a further period of one year (phase III). At the end of thos phase all treatment is stopped and the patients followed-up for any relapse (phase IV). Follow up of the first 100 patients, pemphigus vulgaris (92), pemphigus follaccus (6) and pemphigus erythematosus (2), has.

18.
Indian J Dermatol Venereol Leprol ; 55(2): 116-117, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-28128105

RESUMO

A 24 yew old patient having pemphigus for the last 1 year delivered a female baby after 36 weeks of gestation. The baby had pemphigus like lesions on the skin and a single ulcer on the hard palate. The serum antibody titres of intercellular antibodies in the mother and the baby at the time of delivery were 1:80 and 1: 40 respectively. 1 The lesions in the baby healed completely by the 9th day after birth, without any specific treatment. Three months later the antibody titre in the mother was 1: 40, while in test became negative The baby the baby, the has since shown no recurrence of the lesions.

19.
Indian J Dermatol Venereol Leprol ; 55(2): 131-134, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-28128110

RESUMO

Nasal filter is a simple device consisting of a net mounted in a frame made to fit inside the nostrils. These filters thus are not visible from outside. If a person uses the nasal filters the .u particulate material from the air that the person breathes gets removed and in case the person is allergic to an inhalant antigen, he stops having the allergic symptoms. We tried nasal filters on two females patients aged 32 and 7 years respectively, having topics dermatitis the age of I year, caused by an inhalant (indicated by seasonal aggravations, and spontaneous recovery during brief visits to other towns). Unrig a follow-up of 2 1/2 and 2 years respectively, both the patients experienced almost 80-90% relief from the dermatitis and required only animal treatment.

20.
Artigo em Inglês | MEDLINE | ID: mdl-28134149
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