Managing the challenging cases of pemphigus vulgaris with modified pulse therapy: case series


  • Saraswathy P. Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India
  • Jayanthi N. S. Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India
  • Venkatesh Y. Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India



Pemphigus, Modified pulse therapy, DCP


In pemphigus vulgaris, pulse therapy is a promising modality to achieve better therapeutic response and to minimize the side effects of daily steroids. Here we report 5 different challenging situations where we successfully managed with modification of pulse therapy. Our first case had multiple comorbidities with persistent skin infections managed with dexamethasone and cyclophosphamide pulse (DCP) and interval pulse. The second case was unmarried hypertensive male with poor DLQI managed with Azathioprine pulse therapy. The third case was uncontrolled diabetic patient with pulmonary tuberculosis managed with rituximab. The fourth case was diabetic and hypertensive was managed with one day dexamethasone cyclophosphamide pulse therapy (DCP). The fifth case was not completed family with cushingoid features managed with dexamethasone azathioprine pulse therapy (DAP). Pulse therapy is effective in controlling disease activity in pemphigus. But it can be modified in some situations according to the patient needs.


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

Pasricha J S. Pulse therapy as a cure for autoimmune diseases. Indian J Dermatol Venereol Leprol 2003;69:323-8

Pasricha JS, Khaitan BK. Curative Treatment for Pemphigus. Arch Dermatol. 1996;132(12):1518–9.

Kricheli D, Mwaniki D, Zlotkin-Frušić M, Goldsmith D, Rabinov, et al. The distribution of pemphigus vulgaris-IgG subclasses and their reactivity with desmoglein 3 and 1 in pemphigus patients and their first-degree relatives. Br J Dermatol. 2000;143:337-42.

Reis VM, Toledo RP, Lopez A, Diaz LA, Martins JE. UVB-induced acantholysis in endemic Pemphigus foliaceus (Fogoselvagem) and Pemphigus vulgaris. J Am Acad Dermatol. 2000;42(4):571-6.

Kaul R, Sanjay CJ. Review on Pulse Therapy: A Novel Approach in the Treatment of Pemphigus Vulgaris. J Indian Acad Oral Med Radiol. 2010;22:211-4

Rao PN, Lakshmi TS. Pulse therapy and its modifications in pemphigus: A six year study. Indian J Dermatol Venereol Leprol. 2003;69:329-33.






Case Reports