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Diseases
morbidity
Therapies for Pemphigus
Immunosuppressive Anti-inflammatory
drugs:
drugs:
• Dapsone
• Cyclophosphamide • Anti malarias
• Cyclosporin Drugs
• Azathioprine Antibiotics:
• Methotrexate
• Tetracycline
• Mycophenolate
• Minocycline
mofetil
Not enough data, Expert opinion
Pemphigus treatment in Pemphigus patient
present many clinical dilemmas.
eMedicine Dermatology
Topical treatment for oral lesions
1. cream/ oint. clobetasole propionate 0.05% . (Dermovate®)
apply 1-2 times daily.
2. Triamcinolone (Oracort E®,Sterocort®) 0.1%-0.5%, -may be
used with mouth guard.
3. Mouth rinse with corticosteroids: Dexamethasone elixir 0.04%
(0.5 mg/ml), cyclosporine rinses 100 mg/ml.
4. Intra lesional injections (Triamcinolone acetonide)
most effective for topical treatment.
Side effects –Local and temporary atrophy of skin.
(Jean-Claude, Lancet. 2005)
Adjuvant therapies
With corticosteroids, Not instead
Anti-inflammatory
Immunosuppressive
drugs:
drugs: • Corticosteroids
• Cyclophosphamide • Dapsone
• Cyclosporin
Antibiotics:
• Azathioprine
• Tetracycline
• Methotrexate
• Minocycline
• Mycophenolate
mofetil Not enough data, Expert opinion
Systemic treatment
• Tetracyclines, Nicotinamide
Anti-collagenase activity, suppression of leukocyte
chemotaxis, inhibition of lymphocyte blast
transformation.
Tetracyclines, Nicotinamide – 0.5-2 mg.
Systemic treatment – intravenous
immunoglobulin therapy
Indications:
üA failure of conventional therapy
üPrednisone 60 mg/d for 6 weeks didn’t produce
control of disease
üAdverse effect of conventional treatment
üRapid progressive disease
eMedicine Dermatology
Lichen planus
Management of Oral Lichen
Planus
Good Oral hygiene is essential (erythematous and
possible.
Topical treatment for oral lesions
— Symptomatic ulcerative:
— Topical steroids
— Second line: retinoids. (Vit. A derivates)
Systemic treatment
• Systemic steroids:
Not more effective than topical Corticosteroids.
• Use when :
Unresponsive to topical treatment,
Widespread oral LP with skin, genital,
esophageal or scalp involvement
Topical treatment for oral
lesions
— Retinoids
— Tretinoin 0.05%- Retavit©, Retin A©, Airol© Oint -
Topical use.
— Clinical results show remission after a short time of
treatment.
— Systemic use is less common as primary treatment
due to side effects and short periods of remission.
— Retinoids treatment is an adjunctive treatment.
Systemic treatment
• Systemic steroids:
It is not more effective than topical
Corticosteroids.
• Use when :
Unresponsive to topical treatment,
Widespread oral LP with skin, genital,
esophageal or scalp involvement
. Lodi G, Scully C, Carrozzo M et al. Current
controversies in oral lichen planus : Report of
an international consensus meeting. Part 2.
Clinical management and malignant
transformation. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2005; 100:164-
100:164-178.
Systemic treatment
• Daily dose of Prednisone in range of 40-80 mg usually sufficient
to achieve a response.
• Due to toxicity use when necessary at the lowest dose possible,
and for the shortest duration of time. (Or for brief periods of
time 5-7 days and stop abruptly, or reduce drug by 5-10 mg day
over 2-4 week period).
• If possible to tolerate by patient alternate day administration of
same total dose may minimize adverse effects.
• Start with Topical treatment.
— Immunomudalatory treatment – not common
(detailed before).
— Candida albicans is present in 37% of OLP