WHO Model Prescribing Information: Drugs Used in Skin Diseases
(1997; 132 pages) [French] [Spanish] Ver el documento en el formato PDF
Índice de contenido
Ver el documentoPreface
Ver el documentoIntroduction
Abrir esta carpeta y ver su contenidoParasitic infections
Abrir esta carpeta y ver su contenidoInsect and arachnid bites and stings
Abrir esta carpeta y ver su contenidoSuperficial fungal infections
Abrir esta carpeta y ver su contenidoSubcutaneous fungal infections
Abrir esta carpeta y ver su contenidoBacterial infections
Abrir esta carpeta y ver su contenidoViral infections
Abrir esta carpeta y ver su contenidoEczematous diseases
Abrir esta carpeta y ver su contenidoScaling diseases
Abrir esta carpeta y ver su contenidoPapulosquamous diseases
Ver el documentoCutaneous reactions to drugs
Abrir esta carpeta y ver su contenidoPigmentary disorders
Abrir esta carpeta y ver su contenidoPremalignant lesions and malignant tumours
Abrir esta carpeta y ver su contenidoPhotodermatoses
Cerrar esta carpetaBullous dermatoses
Ver el documentoPemphigus
Ver el documentoBullous pemphigoid
Ver el documentoDermatitis herpetiformis
Ver el documentoAlopecia areata
Ver el documentoUrticaria
Abrir esta carpeta y ver su contenidoConditions common in children
Ver el documentoAcne vulgaris
Ver el documentoPruritus
Ver el documentoTropical ulcers
Abrir esta carpeta y ver su contenidoAntimicrobial drugs
Abrir esta carpeta y ver su contenidoAntifugal drugs
Abrir esta carpeta y ver su contenidoAntiseptic agents
Abrir esta carpeta y ver su contenidoKeratoplastic and keratolytic agents
Abrir esta carpeta y ver su contenidoScabicides and pediculicides
Abrir esta carpeta y ver su contenidoAnti-inflammatory and antipruritic drugs1
Abrir esta carpeta y ver su contenidoAntiallergics and drugs used in anaphylaxis
Abrir esta carpeta y ver su contenidoUltraviolet radiation-blocking agents (sunscreens)
Abrir esta carpeta y ver su contenidoMiscellaneous drugs
Abrir esta carpeta y ver su contenidoAnnex
Ver el documentoSelected WHO Publications of Related Interest
Ver el documentoBack cover
 

Pemphigus

Pemphigus vulgaris and a less severe variant, pemphigus foliaceous, in which the blisters are more superficial and the mucous membranes are not involved, are the most common variants of this condition. Occasionally, particularly after exposure to sunlight, the lesions become confluent and lead to a form of exfoliative dermatitis.

Pemphigus vulgaris is typically a disease of middle age. It is most prevalent in eastern India, in southeast Asia and among persons of Jewish descent. Sometimes cases occur after exposure to penicillamine or captopril and associations have also been described with thymoma, myasthenia gravis and other immunopathological conditions. Painful ulcers often develop in the mouth several months before the skin lesions appear. Fragile flaccid blisters develop in the deeper layers of the epidermis in non-inflamed skin, typically on the scalp, chest and intertriginous areas. They extend readily on digital pressure and often rupture, leaving large areas of weeping denuded skin. Ulceration of mucosal surfaces is common and can be extensive. Untreated, most patients die within 5 years from secondary sepsis, electrolyte imbalance and/or emaciation.

Pemphigus vegetans is a variant of pemphigus vulgaris, in which the skin lesions are largely limited to the scalp and intertriginous areas, and appear as crusted papillomatous lesions. However, most cases eventually progress to pemphigus vulgaris.

Brazilian pemphigus or fogo selvagem is a rapidly spreading form of pemphigus, which occurs epidemically in parts of Brazil.

Treatment

Fluid and electrolyte balance should be carefully monitored. Systemic antimicrobial therapy may be needed for patients with secondary infections.

Compresses soaked in 5% aluminium diacetate, 0.005% silver nitrate, or a 0.01% potassium permanganate solution should be applied to the affected areas every 4 hours. This will facilitate the removal of skin debris from blistered areas and reduce the risk of secondary infection.

High doses of oral corticosteroids are usually required for control. The dose should be gradually reduced once stabilization occurs to the lowest dose that maintains remission. Oral prednisolone or prednisone can be used. Addition of immunosuppressive drugs, such as azathioprine or cyclophosphamide, is often useful when the patient is unable to tolerate the minimum corticosteroid dose that maintains remission. The immunosuppressive effect develops gradually and is usually undetectable until 4-6 weeks after treatment has started. Corticosteroids should be withdrawn before the immunosuppressive drug is discontinued.

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