PULSE CORTICOSTEROID-THERAPY FOR CUTANEOUS DISEASES - EFFICACY AND SIDE-EFFECTS

Pulse corticosteroid therapy has been used for the treatment of variou s dermatologic diseases. Most of the data generated from the use of pu lse steroids to treat dermatologic diseases has been from studies with a limited number of patients. Further data relating the complications and clinical experience with the use of pulse corticosteroids in derm atology is needed. Our purpose was to review our 4-year experience wit h patients who had received purse corticosteroids alone or in conjunct ion with cyclophosphamide at our: inpatient service. Particular attent ion was given to the complications encountered and response to therapy . The medical records of patients who received pulse steroids at our c enter were reviewed with respect to patient demographics, clinical res ponse and complications of therapy. During a period of 4 years, 38 pat ients received pulse corticosteroids alone and 4 received them in comb ination with cyclophosphamide. The conditions treated were: pyoderma g angrenosum, pemphigus vulgaris and foliaceus, systemic sclerosis, hidr adenitis suppurativa, eosinophilic fasciitis, palmar fasciitis, system ic lupus erythematosus, polyarteritis nodosa, eosinophilia myalgia syn drome and a perianal ulcer associated with Crohn's disease. Of the 38 patients treated with pulse steroids alone, 30 (79%) responded favorab ly to therapy. On follow-up for 30 of these patients, 8 were in remiss ion, 11 had improved but had experienced at least one recurrence and 1 1 experienced either no change in their condition or returned to their original condition. The most frequent complication was hyperglycemia (29 of 42 patients) and hypertension (12 of 42 patients). However, the se complications were transient, and therapy was otherwise well tolera ted. Our findings suggest that pulse corticosteroid therapy is efficac ious and relatively safe. Careful monitoring of cardiovascular, respir atory, renal and electrolyte status should be performed and inpatient treatment is recommended.