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SHORT COMMUNICATION
Year : 1992  |  Volume : 58  |  Issue : 3  |  Page : 201-203

Gold therapy in a case of childhood pemphigus vulgaris




Correspondence Address:
K N Sarveswari


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A 12-year-old boy had pemphigus vulgaris. When he did not improve on systemic steroid in 15 days, injection gold sodium thiomalate was added. Gold helped in reducing the dose of steroid and the child achieved complete remission after 14 doses of gold. Gold therapy is a useful adjuvant to systemic steroids in the management of pemphigus.


Keywords: Pemphigus vulgaris, Gold therapy


How to cite this article:
Sarveswari K N, Sumitra S, Ysudian P. Gold therapy in a case of childhood pemphigus vulgaris. Indian J Dermatol Venereol Leprol 1992;58:201-3

How to cite this URL:
Sarveswari K N, Sumitra S, Ysudian P. Gold therapy in a case of childhood pemphigus vulgaris. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Jun 19];58:201-3. Available from: http://www.ijdvl.com/text.asp?1992/58/3/201/3794



  Introduction Top


Pemphigus vulgaris in children is rare [1] It is associated with high mortality if untreated and has a high morbidity rate when treated with systemic corticosteriods for prolonged periods. Although undesirable side effects may accompany its use, gold sodium thiomalate offers a reasonable alternative to long term corticosteroid therapy in pemphigus. [2] A case of pemphigus vulgaris in a 12 year-old boy, treated with gold is described.


  Case Report: Top


A 12-year-old boy had blisters of 3 months duration. Blisters were flaccid and widespread involving face, scalp, trunk, scrotum, palms and soles [Figure - 1] Erosions were seen in the hard palate. Skin biopsy showed suprabasal cleft and acantholytic cells. [Figure - 2] Immunofluorescence study was not done.

The child was given 30 mg of prednisolone per day. As fresh blisters continued to appear and as patient was toxic even after increasing the dose of prednisolone to 40 mg per day, gold therapy was considered. Hematological and renal baseline parameters were checked, and injection gold sodium thiomalate (Injection Myocrisin) was given on the fifteenth day of admission. A test dose of 1 mg was given intradermally, followed by 10 mg intramuscularly at weekly intervals and 40 mg per day of oral prednisolone was continued. By the 4th injection of gold, no fresh blisters were seen and steriods were tapered to 25 mg per day. With the 8th dose of intramuscular gold, prednisolone was reduced to 15 mg per day and patient was discharged in apparent good health. He is now in complete remission (14 doses of gold completed) with weekly injections of 10 mg of gold, and oral prednisolone 10 mg per day [Figure - 3]. No side effects of gold, like pruritus, rashes, protinuria, bone marrow toxicity or nephrotoxicity were noted.


  Comments Top


Gold therapy can be used effectively in controlling childhood pemphigus. As there is a lag time of 6 weeks, or more in between the institution of gold therapy and response to the drug, concomitant systemic steroid administration initially is desirable. [3] After the lag period, the dose of steriods can be gradually lowered while continuing with gold sodium thiomalate.

Maintenance dose of gold varies with each patient. A total dose of 1 gram should not be exceeded.

Considering the relatively uneventful course of gold therapy in our case, it is worthwhile trying gold as an adjuvant to steroid therapy [4] in childhood pemphigus.

It enables drastic reduction in steroid dosage which otherwise could have many undesirable side effects in a growing child.

 
  References Top

1.Bernard W, Berger MD, Herbert S, et al. Pemphigus vulgaris in a 31/2 years old boy. Arch Dermatol 1973: 170; 433-4.  Back to cited text no. 1    
2.Penneys NS, Eaglstein WH, Frost F. Management of Pemphigus with gold compound . A long term follow up report. Arch Dermatol 1976: 112 185-7.  Back to cited text no. 2    
3.Poulin Y, Perry HU, Muller SA. Pemphigus Vulgaris : results of treatment with gold as a steroid sparing agent in a series of thirteen patients. J Am Acad-Dermatol 1983 : 11 : 851-71.  Back to cited text no. 3    
4.Bystryn JC. Adjuvant therapy of pemphigus. Arch Dermatol 1984: 120: 941 -51.  Back to cited text no. 4    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

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