Treatment of Bullous Dermatoses with Ciclosporin (CyA)

Abstract

Today pemphigus vulgaris, including its clinical variants pemphigus foliaceus, pemphigus erythematosus Senear-Usher etc., is generally accepted to be an autoimmune disease with intraepithelial IgG antibodies. For that reason treatment aims at achieving the most effective immunosuppression possible by the systemic administration of steroids and azathioprine and occasionally also methotrexate [7]. If the course of the disease is particularly severe and serum antibody levels are high, plasmapheresis is tried as an additional means of treatment [7, 8]. However, this form of therapy involves considerable side effects because the immunosuppression is not selective. Almost all proliferative cell systems are more or less equally affected by the cytotoxic effects of the above-mentioned drugs, and in particular the immunocompetent cells and the haemopoietic system. A number of authors also report an increased incidence of malignant tumours in patients who receive such immunosuppressive treatment over a prolonged period [6]. In addition there are always patients whose bullous condition cannot be arrested or healed despite the prolonged use of immunosuppressives in high doses.