Early treatment of pemphigus does not improve the prognosis. A review of 53 patients

Background: With the introduction of systemic steroids to control pemphigus vulgaris the prognosis and survival of these patients has changed dramatically. However, in contrast to their beneficial effects, in a once almost inevitably fatal disease, the steroid therapy has created other problems, including cases of mortality. Objective: To analyze the possible factors influencing the course and prognosis of the disease and to review the steroid complications in our patients. Methods: 53 patients with pemphigus, admitted to the Department of Dermatology of Ichilov Hospital between 1965 and 1989, were studied. Results: The total mortality rate of 26.4% (14 patients of 53) in the present study is within the range found by others. A long pretreatment period did not lead to a worse prognosis. Patients with a pretreatment period longer than 6 months had a lower mortality rate than patients with a pretreatment period shorter than 6 months. The age of the patient played a role in determining the outcome of the disease as patients older than 60 years had a worse prognosis compared with patients younger than 50 years, 37.5% of the patients over 60 years died, as compared with a mortality rate of zero in patients younger than 50. This is in accordance with data found by others. Adjuvant therapy with azathioprine was found to improve the prognosis. Patients receiving azathioprine in addition to steroids had a significantly lower mortality rate and fewer exacerbations. Patients with involvement of the mucosa alone had a higher mortality rate than patients with involvement of the skin only and those with involvement of both skin and mucosa had the highest mortality rate. Conclusions: Early treatment of pemphigus does not improve the prognosis. Therefore, immediate high-dose treatment in every case of pemphigus doesn't seem absolutely essential any more.