Modifications of pulse therapy in pemphigus: a retrospective study of 72 patients

Neela V. Bhuptani, Khushbu P. Chauhan, Monal M. Jadwani, Pooja Raja


Background: Pulse therapy defines as the administration of supra-pharmacologic doses of drugs in an intermittent manner to enhance the therapeutic effects and reduce the side effects. Dexamethasone-Cyclophosphamide pulse (DCP) therapy is known since 1986 but there are certain limitations due to side effects of cyclophosphamide.

Methods: A retrospective study was carried out where 72 patients of pemphigus were treated with modified pulse therapy like DCP, DAP, DMP from 2006-2016. Modifications were made in DCP therapy protocol and substitution of cyclophosphamide with either azathioprine or methotrexate in few patients.

Results: Male to female ratio observed was 1:0.7. Majority of them belonged to age group of 31-40 years (41.66%) followed by 41-50 years (33.3%). Maximum number of patients had pemphigus vulgaris (86.1%) followed by pemphigus foliaceous (12.5%) and IgA pemphigus (1.38%). Good response was observed in patients who took pulse therapy regularly.

Conclusions: Modifications to the original DCP therapy protocol were found to be very effective, useful and it shortened the duration of phase I. Side effects were minimal and manageable.


Pulse therapy, Dexamethasone-cyclophosphamide therapy, Dexamethasone-azathioprine therapy, Dexamethasone-methotrexate therapy

Full Text:



Pasricha JS. Pulse therapy in pemphigus and other diseases. 2nd ed. New Delhi: Pulse Therapy and Pemphigus Foundation; 2000.

Sethy PK, Khandpur S, Sharma VK. Randomized open comparative trial of dexamethasone. cyclophosphamide pulse and daily oral cyclophosphamide versus cyclophosphamide pulse and daily oral prednisolone in pemphigus vulgaris. Indian J Dermatol Venereol Leprol. 2009;75:476-82.

Bell PR, Briggs JD, Calman KC, Paton AM, Wood RF, Macpherson SG, et al. Reversal of acute clinical and experimental organ rejection using large doses of intravenous prednisolone. Lancet. 1971;1:876-80.

Pasricha J, Gupta R. Pulse therapy with dexamethasone in reiter’s disease. Indian J Dermatol Venerol Leprol. 1982;48:358-61.

Pasricha J. Gupta R. Pulse therapy with dexamethasone cyclophosphamide in pemphigus. Indian J Dermatol Venerol Leprol. 1984;50:199-203.

Huilgol SC, Black MM. Management of the immunobullous disorders. Pemphigus. Clin Exp Dermatol. 1995;20:283-93.

Rao P N, Lakshmi T S.Pulse therapy and its modifications in pemphigus: A six year study. Indian J Dermatol Venerol Leprol. 2003;69:329-33.

Khaitan BK, Sheshadri D, Kathuria S, Gupta V. Immunobullous disorders. In: Sacchidanand S, editor. IADVL Textbook of dermatology (4th ed). Mumbai: Bhalani Publishing House; 2015;25:933-6.

Chryssomallis F, DimitriadesA, Chaidemenos GC, PanagiotidesD, Karakatsanis G. Steroid-pulse therapy in pemphigus vulgaris: long term follow-up. Int J Dermatol. 1995;34:438-42.

Kandan S, Thappa DM. Outcome of dexamethasone−cyclophosphamide pulse therapy in pemphigus: A case series. Indian J Dermatol Venereol Leprol. 2009;75:373-8.

Sacchidanand S, Hiremath NC, Natraj HV, Revathi TN, Rani TS, Pradeep G et al. Dexamethasone cyclophosphamide pulse therapy for autoimmune vesiculobullous disorders at Victoria hospital, Bangalore. Dermatol Online J. 2003;9:2.