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Treatment of pemphigus with intravenous immunoglobulin
Bystryn, Jean-Claude; Jiao, Diane; Natow, Steven
BACKGROUND: Intravenous immunoglobulin (IVIg) has recently been advocated as a treatment for pemphigus, but the results of published studies are in conflict. This study was conducted to re-examine the effectiveness of IVIg for the immediate control of active disease and to study the mechanisms of its action. METHODS: Six patients with active pemphigus vulgaris unresponsive to conventional therapy with high doses of corticosteroids were treated with IVIg (400 mg/kg per day for 5 days) and concurrently given cyclophosphamide (100-150 mg/d). The primary end points were healing of skin lesions and changes in the level of intercellular antibodies and steroid dose. RESULTS: New lesions ceased to form within 1 week of initiating IVIg therapy, and within 2 weeks the extent of existing skin lesions was reduced by 80% or more in all but one patient. Within 3 weeks, steroid doses were reduced by an average of 41%. The improvement was more rapid than that in patients previously treated with similar doses of steroids and cytotoxic agents at the same institution. Clinical improvement was associated with a rapid decline in pemphigus antibodies whose levels decreased by 72% within 1 week of initiation of IVIg therapy. The rapidity and extent of this decline were similar to those achieved with intensive plasmapheresis. The decline was not due to blocking the synthesis or the immunologic activity of intercellular antibodies by IVIg, suggesting that it resulted from increased immunoglobulin catabolism. CONCLUSIONS: These results indicate that IVIg can effectively and rapidly control active pemphigus unresponsive to conventional therapy and suggest that the mechanism of its action is decreasing serum levels of intercellular antibodies
PMID: 12196744
ISSN: 0190-9622
CID: 39601
Focal acral hyperkeratosis [Case Report]
Natow, S
PMID: 11328631
ISSN: 1087-2108
CID: 854092
Acanthosis nigricans and confluent reticulated papillomatosis
Chapter by: Natow S; Natow A
in: Current dermatologic diagnosis & treatment by Freedberg IM; Sanchez MR [Eds]
Philadelphia : Lippincott Williams & Wilkins, 2001
pp. 2-3
ISBN: 0781735319
CID: 3666
Neuralgia
Chapter by: Natow S; Natow A
in: Current dermatologic diagnosis & treatment by Freedberg IM; Sanchez MR [Eds]
Philadelphia : Lippincott Williams & Wilkins, 2001
pp. 124-125
ISBN: 0781735319
CID: 3726
Opportunistic skin diseases associated with HIV infections
Chapter by: Natow S; Friedman-Kien A
in: Current dermatologic diagnosis & treatment by Freedberg IM; Sanchez MR [Eds]
Philadelphia : Lippincott Williams & Wilkins, 2001
pp. 134-135
ISBN: 0781735319
CID: 3730
Papular urticaria
Chapter by: Natow S; Natow A
in: Current dermatologic diagnosis & treatment by Freedberg IM; Sanchez MR [Eds]
Philadelphia : Lippincott Williams & Wilkins, 2001
pp. 142-143
ISBN: 0781735319
CID: 3734