Clinical aspects of steroid resistance in autoimmune pemphigus


Cite item

Full Text

Abstract

Some patients with autoimmune pemphigus (AP) are resistant to systemic glucocorticoid monotherapy, that is, are steroid-resistant. A retrospective analysis of case histories of 118 AP patients was carried out to detect the probable trigger factors promoting the manifestation of steroid resistance during the first year of therapy and showed that steroid-resistant patients could not indicate the cause of AP exacerbation 5 times more often than other patients. It seems that steroid resistance of these patients was caused by genetic factors. Steroid resistance was detected in all patients with paraneoplastic pemphigus. A relationship between stress and exacerbation was detected in only steroid-resistant patients. Frequent exacerbations of AP because of insufficiently hight dose of systemic glucocorticoids (SGC) and rapid reduction of SGC dose were detected in steroid-resistant patients and in patients without steroid resistance. No significant relationships between steroid resistance and clinical manifestations of AP, location of efflorescence, and Nikolsky’s symptom were detected.

About the authors

N. P Teplyuk

I.M. Setchenov First Moscow State Medical University

Email: Teplyukn@gmail.com
доктор мед. наук, профессор; Кафедра кожных и венерических болезней лечебного факультета им. В.А.Рахманова

A. A Lepekhova

I.M. Setchenov First Moscow State Medical University

Email: anfisa.lepehova@yandex.ru
аспирант; Кафедра кожных и венерических болезней лечебного факультета им. В.А.Рахманова

References

  1. Потекаев Н.С., Кочергин Н.Г., Теплюк Н.П., Паничкина Г.С., Заборова В.А., Лысенко Л.В., Миченко А.В. Терапевтическая тактика при стероидрезистентной пузырчатке. Российский журнал кожных и венерических болезней. 2003; 2: 11-6.
  2. Теплюк Н.П., Кузьмина Т.С., Давыдовская Н.И., Дулькин И.С., Куприянова А.Г. Случай стероидрезистентной пузырчатки с летальным исходом. Российский журнал кожных и венерических болезней. 2006; 4: 58-9.
  3. Antonucci A., Negosanti M., Tabanelli M., Varotti C. Treatment of refractory pemphigus vulgaris with anti-CD20 monoclonal antibody (rituximab): five cases. J. Dermatol.Treat. 2007; 18(3): 178-83.
  4. Dupuy A., Viguier M., Bedane C., Cordoliani F., Blaise S., Aucouturier F., et al. Treatment of refractory pemphigus vulgaris with rituximab (an-ti-CD20 monoclonal antibody). Arch. Dermatol. 2004; 140(1): 91-6.
  5. Goh M.S., McCormack C., Dinh H.V., Welsh B., Foley P., Prince H.M. Rituximab in the adjuvant treatment of pemphigus vulgaris: a prospective open-label pilot study in five patients. Br. J. Dermatol. 2007; 156(5): 990-6.
  6. Теплюк Н.П., Духанин А.С., Огурцов С.И., Белышева Т.С. Система внутриклеточных посредников в лимфоцитах больных истинной акантолитической пузырчаткой. В кн.: Сборник тезисов XIIРоссийского национального конгресса "Человек и лекарство". Москва, 18-22 апреля 2005 г. М.; 2005.
  7. Теплюк Н.П., Огурцов С.И., Белышева Т.С. Влияние преднизоло-на на обмен вторичных мессенджеров в лимфоцитах больных при истинной акантолитической пузырчатке. Бюллетень экспериментальной биологии и медицины. 2005; 9: 308-10.
  8. De la Fuente H., Baranda L., Hernandez M.I., Torres-Alvarez B., Llorente L., Layseca E., Gonzalez-Amaro R. Lack of involvement of P-glycoprotein (P-gp) in pemphigus patients with poor response to steroid therapy. J. Dermatol. Sci. 2002; 28(3): 219-26.
  9. Nambiar M., Enyedy E., Fisher C., Warke V.G., Juang Y.T., Tsokos G.C. Dexametasone modulates TCR zeta chain expression and antigen receptor - mediated early signaling events in human T-lymphocytes. Cell Immunol. 2001; 208(1): 62-71.
  10. Joly P., D’Incan M., Musette P. Rituximab for pemphigus vulgaris. N. Engl. J. Med. 2007; 356(5): 521-2.
  11. Gross K.L., Lu N.Z., Cidlowski J.A. Molecular mechanisms regulating glucocorticoid sensitivity and resistance. Mol. Cell Endocrinol. 2009; 300(1-2): 7-16.
  12. Hulleman E., Kazemier K.M., Holleman A., Vanderweele D.J., Rudin C.M., Broekhuis M.J., et al. Inhibition of glycolysis modulates prednisolone resistance in acute lymphoblastic leukemia cells. Blood. 2009; 113(9): 2014-21.
  13. Handjani F., Shahbazi F. Clinical features of 150 patients with pemphigus in southern Iran. J. Eur. Acad. Derm. Venereol. 2004; 18(Suppl. 2): 179.
  14. Uzun S., Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J. Am. Acad. Dermatol. 2006; 54(3): 411-5.
  15. Махнева Н.В. Симптом Никольского в клинике аутоиммунных дерматозов. Российский журнал кожных и венерических болезней. 2008; 5: 26-9.

Copyright (c) 2014 Eco-Vector


 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies