The use of plasmapheresis and immunosuppression in the treatment of pemphigus vulgaris

Background: Pemphigus vulgaris is an autoimmune blistering disease for whic h the mainstay of treatment is systemic corticosteroids and immunosuppressa nts. This therapy had reduced the mortality of pemphigus; however, it is as sociated with significant morbidity. Objective: The objective of this study was to assess the group's experience with. plasmapheresis in the treatment of pemphigus vulgaris and report on its utility. Methods: Seven patients with severe or resistant pemphigus vulgaris underwe nt a series of 5 plasma exchanges over an average of 8 days. Immunosuppress ive drugs were administered immediately after plasmapheresis to prevent the "rebound" flare of disease that can occur after plasmapheresis. Results: Remission was induced in 4 patients, partial remission was induced in 2 patients, and 1 patient continues to have active disease. Conclusion: This study suggests that plasmapheresis is a useful interventio n in patients with pemphigus vulgaris who are not responding to standard th erapy or who require unacceptably high doses of steroids or immunosuppressa nts.