—We appreciate Dr Krain's interesting and provocative letter.
The ambiguity in our report regarding the number of patients in Dr Krain's study resulted from our interest in patients with pemphigus vulgaris, 49 of whom were discussed in his report and six of whom were in remission.
Dr Krain's letter contradicts his published data. He reported 111 toxic events in 45 patients (in his Table 5), including two deaths possibly attributable to systemic corticosteroid administration.1 While mild forms of gold toxicity are observed commonly, nephrotic syndrome, agranulocytosis, exfoliative dermatitis, and erythema nodosum in association with chrysotherapy is rare. For example, as far as we know, our case report of goldassociated erythema nodosum is the only one in the literature.2 During five years of collecting information on adverse cutaneous reactions to gold compounds, part of which we reported previously,3 only one case of exfoliative dermatitis has been observed. In
Penneys NS, Eaglstein W, Frost P. Gold Compounds vs Corticosteroids in the Treatment of Pemphigus Vulgaris-Reply. Arch Dermatol. 1976;112(10):1467. doi:10.1001/archderm.1976.01630340079026