Pemphigus accompanied by the appearance on healthy skin or mucous membranes of the bubbles have a tendency to spread and merge.
It can occur at any age, but most often affects persons 40-60 years, women suffer more than men.
symptoms of pemphigus
Vulgar (common) form - on normal skin or mucous membranes appear isolated bubbles sometimes reaching values walnut with a transparent, gradually mutneyuschim rarely bloody contents. Some bubbles subsides, and the contents of shrinking in the crust, and other burst form ulcerations.
Seborrheic (erythematous), hand-foot-Senir Usher begins usually on the face, back, chest and scalp. Small size bubbles appear, rapidly shrinking in the grayish-yellowish crusts, on removal of detecting a wound surface.
Pemphigus pemphigus: a disease of the mouth cavity and limbs - rash on the fingers and toes, hands and soles; often accompanied by the appearance of painful blisters, ulceration of the mucous membrane of the cheeks and tongue, low-grade fever; pathogen - Coxsackie virus.
Diagnosis of pemphigus carried dermatologists and is based on aggregate survey results, cytological, histological and immunological examination. In all forms of the disease say the deposition of immunoglobulin G in the surface layers of the skin.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
pemphigus treatment
- For the treatment used hormones, such as oral prednisolone and locally on the affected area - betamethasone.
Pemphigus is one of the few diseases in which the appointment is made hormones for health reasons, as the existing contraindication in these cases become relative. Stop taking hormones or reduce their daily dose recommended very carefully and gradually. Thus, the treatment as they fall clear improvement daily hormone dose was gradually reduced, about 1 every 4-5 days to 2.5-5 mg prednisolone until until a minimum effective dose of hormone supports, whose introduction provides remission disease.
- Combined use of cytotoxic drugs, immunosuppressive (Sandimmune) hormone preparations It allows for a shorter time and at lower daily doses of hormones to achieve good results in the treatment of pemphigus.
Azathioprine is used in 2-4 divided doses for a day in combination with hormones.
Methotrexate is used 1 time per week.
Sandimmun true for patients with pemphigus used in combination with hormones, and the hormone daily dose is decreased in 3-4 times, and corresponds to 25-50 mg of prednisone. The first 2 days to assess the tolerability of the drug, Sandimmune is administered in half the dose in subsequent daily dose is divided into 2 doses, morning and evening, every 12 hours. Reducing the daily dose of Sandimmun begin after the healing of existing ulcers.Complete purification of the skin should not be the ultimate goal of treatment. After remission the patient followed by taking the lowest effective maintenance dose of Sandimmun, which must be selected individually. The dosage of such drug can be prolonged (2-4 month) used as maintenance therapy.
- For adjunctive therapy of pemphigus have successfully used methods of blood purification - hemosorbtion, plasmapheresis.
hemosorption effect is explained by the possibility of the removal of immunoglobulins, circulating immune complexes, and other disease-causing components. Hemosorption may be carried out in patients with severe concomitant diseases (diabetes diabetes, Hyperthyroidism, atherosclerosis and etc.).
Plasmapheresis - a transfusion of plasma with 7-14 days interval. In each procedure removed from 500 to 2,000 ml of plasma and instead it is injected fresh donor plasma or plasma substitute. Thus there is a removal from the blood of patients with circulating immune complexes. - Photochemotherapy with pemphigus: the essence of the method is to inactivate blood cells by G-methoxypsoralen combined with ultraviolet irradiation of blood cells and reintroducing them into the bloodstream. The effectiveness of the method is high due to the purification of blood from toxic substances immunoglobulins.
- For the prevention of disorders of electrolyte balance used drugs potassium, calcium.
Pemphigus is prolonged for years, with periods of exacerbation and subsided.