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How Long Should I Continue Medrol And Ocid 20 For Pemphigus Vulgaris?
Question: I have been diagnosed with pemphigus vulgaris since Aug 2014. Was on Medrol 32 mg for 5 days , then tapered to 24, 16, 8 over the next 15 days. Continued with Ayurvedic medicines. But symptoms flared up. Since last 10 days on Medrol 32 mg for 6 days, then tried to taper to 24 mg for last 3 days but symptoms began reoccurrng. Currently since today on 32 mg Medrol + OCID 20 twice a day. How long should I continue with the medication?
Brief Answer:
Taper steroids slowly;add other immunosoppressives
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Pemphigus vulgaris is an autoimmune blistering disease characterised by flaccid intraepidermal bullae, which rupture easily and leave behind painful erosions. The erosions can involve the scalp, oral mucosa, lips, trunk and abdomen, groin and genitals.
Steroids/Glucocorticoids are central to the management of pemphigus vulgaris because they are antiinflammatory, immunosuppresive.
You have been on Methylprednisolone (Medrol), which is an Oral glucocorticoid.
Once the disease activity is well controlled with a particular dose of oral glucocorticoids (By "well controlled", I mean to say-- No new lesions for at least 2 weeks and previous lesions healing or healed); then streoids can be tapered by 50% every 2 weeks provided no new lesions appear during the tapering (but here you mention that you tapered to 24, 26,8... all of them in just 15 days, which is too soon! and therefore the relapse)
Moreover, since daily oral steroids have a lot of adverse effects like weight gain, weakening of the bones (osteoporosis), diabetes, high blood pressure, glaucoma, cataracts etc they should not be continued alone forever; patients should be simultaneously started on various other safer immnosuppressives (steroid sparing agents) like cyclophosphamide, Mycophenolate Mofetil, Azathioprine, OR Methotrexate.
These immunosuppressive agents take time to take control (4-6 weeks), therefore they should always be started simultaneously with oral steroids, so that by the time steroids are to be tapered, these immunosuppressives would take full effect of the disease.
Steroids can be tapered gradually (by 50 % every 2 weeks) and finally stopped once the steroids sparing agents take full control of the disease.
These medicines are prescription drugs and should always be taken under the supervision of a dermatologist and after appropriate lab testing.
Kindly take another appointment with your treating doctor (preferably a dermatologist). Your dermatologist will tell you in more detail about these.
Hope this helps
Regards
Taper steroids slowly;add other immunosoppressives
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Pemphigus vulgaris is an autoimmune blistering disease characterised by flaccid intraepidermal bullae, which rupture easily and leave behind painful erosions. The erosions can involve the scalp, oral mucosa, lips, trunk and abdomen, groin and genitals.
Steroids/Glucocorticoids are central to the management of pemphigus vulgaris because they are antiinflammatory, immunosuppresive.
You have been on Methylprednisolone (Medrol), which is an Oral glucocorticoid.
Once the disease activity is well controlled with a particular dose of oral glucocorticoids (By "well controlled", I mean to say-- No new lesions for at least 2 weeks and previous lesions healing or healed); then streoids can be tapered by 50% every 2 weeks provided no new lesions appear during the tapering (but here you mention that you tapered to 24, 26,8... all of them in just 15 days, which is too soon! and therefore the relapse)
Moreover, since daily oral steroids have a lot of adverse effects like weight gain, weakening of the bones (osteoporosis), diabetes, high blood pressure, glaucoma, cataracts etc they should not be continued alone forever; patients should be simultaneously started on various other safer immnosuppressives (steroid sparing agents) like cyclophosphamide, Mycophenolate Mofetil, Azathioprine, OR Methotrexate.
These immunosuppressive agents take time to take control (4-6 weeks), therefore they should always be started simultaneously with oral steroids, so that by the time steroids are to be tapered, these immunosuppressives would take full effect of the disease.
Steroids can be tapered gradually (by 50 % every 2 weeks) and finally stopped once the steroids sparing agents take full control of the disease.
These medicines are prescription drugs and should always be taken under the supervision of a dermatologist and after appropriate lab testing.
Kindly take another appointment with your treating doctor (preferably a dermatologist). Your dermatologist will tell you in more detail about these.
Hope this helps
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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