Forty-six patients with pemphigus were placed on treatment with corticosteroids between April, 1950, and October, 1959. Their state was determined as of Oct. 1, 1961.
There were 32 patients with pemphigus vulgaris, of whom 21 were living and ambulatory on Oct. 1, 1961. Of the 21 living patients, 5 were free of lesions without treatment; 5 were free of lesions but were still receiving treatment; and 11 had a few lesions and were receiving treatment. Eleven patients had died. At the time of death 5 were free of lesions; 4 had a few lesions; and 2 showed extensive involvement. Of the 11 deaths 3 were attributable and 3 probably attributable to therapy with corticosteroids; while 5 patients had died of unrelated causes.
One patient with pemphigus vegetans was free of lesions without treatment.
Of the 11 patients with pemphigus foliaceus, 6 were free of lesions and without treatment. Five patients had died, 4 of unrelated causes while free of lesions, and I generalized pemphigus foliaceus while not under our care andnot receiving corticosteroids.
Of 2 patients with pemphigus erythematosus one was free of lesions and the other had a few lesions. Neither was receiving any treatment.
In pemphigus vulgaris early diagnosis and prompt treatment with high doses of corticosteroids is of great importance. If vigorous and prolonged initial treatment is given, it is more likely that the patient can be carried on small maintenance doses than if the initial treatment is less intensive in amount and duration. After the initial administration of high doses the dosage is reduced in a "logarithmic fashion" to the lowest level adequate for maintenance. During exacerbations large doses of corticosteroids are again required. In contrast to early pemphigus vulgaris, treatment may be withheld in early pemphigus foliaceus so long as the disease remains localized and mild.
Side-reactions to the corticosteroids were rather common, especially compression fractures of vertebral bodies, bacterial infections, peptic ulcer, and mental changes. In 2 patients central posterior subcapsular cataracts developed as a result of treatment with large doses of corticosteroids.
Concurrent administration of testosterone and estrogens was regarded as effective prophylaxis against vertebral fractures.