Js Pasricha

Drugs causing fixed eruptions

Forty patients having fixed drug eruptions were subjected to provocation tests. Twelve patients failed to complete the provocation tests, while in the remaining, the causative drugs were shown to be tetracyclines (6), analgin (metamizole) (6), oxyphenbutazone (5), phenobarbitone (4), sulphadiazine (3), sulphaphenazole (2), penicillin (1), sulphadimethoxone (1), Saridon (1), sulphadimidine (1) and sulphamethoxypyridazine (1). There was evidence of cross‐sensitivity between tetracycline and demethylchlortetracycline and also between oxyphenbutazone and phenylbutazone, but not between different sulphonamides. In 2 cases, the minimum dose of the drug capable of reactivating the lesions was 100 mg of sulphadiazine and 50 mg of Saridon respectively.

Intermittent high-dose dexamethasone-cyclophosphamide therapy for pemphigus

Since 1982, we have treated 79 pemphigus patients with an arbitrarily designed regimen of 100 mg dexamethasone dissolved in 5% glucose given by an intravenous infusion over 1 h, daily on 3 consecutive days and in addition, 500 mg cyclophosphamide on day 1 only. The intermittent high doses (IHD) of dexamethasone are repeated every 2–4 weeks, and the patient continues to take 50 mg/day oral cyclophosphamide.

Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast-spreading disease

Background. Systemic corticosteroids can arrest the progression of vitiligo and lead to repigmentation in a significant proportion of patients, but may also produce unacceptable side effects. To minimize the side effects, we tried a new approach using mini‐pulse therapy with betamethasone.

EFFECT OF PROLONGED TREATMENT WITH LEVAMISOLE ON VITILIGO WITH LIMITED AND SLOW‐SPREADING DISEASE

Background. For an effective treatment of vitiligo, it Is as important to arrest the progression of the disease (if it is still active) as it is to induce repigmentation in existing lesions. In patients having limited and slow‐spreading vitiligo, we evaluated the efficacy of levamisole to control the activity of the disease process and to induce repigmentation of the vitiliginous areas.

Treatment of pemphigus with cyclophosphamide

Cyclophosphamide was ineffective in controlling acute disease activity in nine of eleven pemphigus patients, but when given during the remission phase even 50 mg cyclophosphamide per day was sufficient to prevent subsequent relapses in all the patients for quite long periods of follow‐up. This small dose of cyclophosphamide could be given to outpatients and there were no side effects.

Independent lesions of fixed eruption due to two unrelated drugs in the same patient

Cross-sensitivities between various drugs causing fixed eruptions are well known (Welsh, 1952,1955, 1961; Dougherty, 1952; Browne, 1964; Fitzpatrick, 1965; Tarnowski, 1970; Nayyar & Pasricha, 1972; Pandhi & Bedi, 1975 i Pasricha, 1978) and poly-sensitivities have also been recorded (Welsh, 1961; Pasricha, 1978). But occurrence of two groups oflesions in the same patient, one group reacting to one drug and the other group to another unrelated drug, is rare. There is only one report of a patient reacting to arsphenamine and phenobarbitone (Chargin, 1938). We are reporting a case reacting to Anaigin (metamizole) and tetracycline. I

Azathioprine as a Corticosteroid Sparing Agent for the Treatment of Dermatitis Caused by the Weed Parthenium

Air-borne contact dermatitis caused by Parthenium hysterophorus is a serious problem in India. Patients with this condition have to use corticosteroids regularly in order to maintain clinical remissions, but prolonged usage causes serious side-effects. The weed cannot be eradicated. We have used 3 therapeutic regimens with azathioprine, which led to an effective control with minimal side-effects even when used for long periods. A total of 22 patients (group I) were given 50 mg azathioprine twice a day; 11 patients (group II) received 50 mg azathioprine per day and 300 mg azathioprine every 28 days, and 10 patients (group III) were given 50 mg azathioprine twice a day along with 300 mg azathioprine every 28 days. The duration of treatment varied from 6 months to 3 years. Twenty patients in group I and 9 patients each in groups II and III had complete remission. Nine, 7 and 6 patients in the respective groups needed additional oral betamethasone 1-2 mg per day for brief periods only during the peak season in order to maintain complete remission. One patient in each group had only partial relief. The need for oral betamethasone during the second and the third year was further reduced. One patient each in group I and group II could not continue azathioprine due to the side-effects of the drug.

Pemphigus and Hodgkin's disease

The coexistence of pemphigus and Hodgkins disease has not previousiy been reported. We observed a patient who developed pemphigus vulgaris nearly 2 years after Hodgkins disease had been found to be present, Subsequently the diseases ran a parallel course in three relapses and remissions. The remissions were induced by cyclophosphamide. The possibility that Hodgkins disease predisposed the patient to pemphigus is considered in view of the recent postulate that thymus‐dependent lymphocytes prevent the development of autoimmunity, and that the diseases associated with depression of cell mediated immunity can lead to the development of autoimmune phenomena.

Pattern of cross-sensitivity between 4 Compositae plants, Parthenium hysterophorus, Xanthium strumarium, Helianthus annuus and Chrysanthemum coronarium, in Indian patients.

To assess the pattern of cross‐sensitivity between 4 members of the Compositae family, namely Parthenium hysterophorus L., Xanthium strumarium L., Helianthus annuus L. and Chrysanthemum coronarium L., 63 patients clinically diagnosed to have airborne contact dermatitis, and 51 controls having well‐defined patterns of contact dermatitis caused by agents other than plants, were patch tested with measured amounts of standardized aqueous extracts of these plants. Positive reactions were obtained in 62 patients and 13 controls with Parthenium hysterophorus, in 47 patients and 9 controls with Xanthium strumarium, in 7 patients and 2 controls with Helianthus annuus. and in 13 of the 57 patients and one out of 28 controls tested with Chrysanthemum coronarium. 2 patients were allergic to all 4 of the plants; 14 patients to 3 plants, namely Parthenium. Xanthium and Chrysanthemum in 9 cases and Parthenium. Xanthium and Helianthus in 5 cases; 32 patients to 2 plants, namely Parthenium and Xanthium in 30 cases, and Parthenium and Chrysanthemum, and Xanthium and Chrysanthemum in 1 case each; 15 patients were allergic to 1 plant only, that being Parthenium. All the 47 patients allergic to Xanthium. 13 patients allergic to Chrysanthemum and 7 patients allergic to Helianthus were positive with some other plant as well. There was 1 patient who was allergic to Xanthium and Chrysanthemum but not to Parthenium. The titre of contact hypersensitivity (TCH) determined in the patients allergic to Parthenium, Xanthium and Helianthus showed values that varied widely with each plant in different patients, and there was no parallelism between the TCH with various plants. In 36 patients, the TCH was highest with Parthenium and in 3 patients with Xanthium. In 7 patients the TCH was the same with Parthenium and Xanthium The TCH with Helianthus was lower than or equal to that with the other plants. Thus, it seems that most of the patients in this group were primarily sensitized to Parthenium, while in a few cases Xanthium was the primary sensitizer. Several of these cross‐reacted with other Compositae plants. One patient from Srinagar, where Chrysanthemum is more prevalent while Parthenium has not yet infiltrated, showed the severest patch test reaction to Chrysanthemum, while the reactions to Parthenium and Xanthium were milder. He was possibly sensitized primarily to Chrysanthemum and cross‐reacted with Parthenium and Xanthium.

Pituitary–adrenal function following dexamethasone–cyclophosphamide pulse therapy for pemphigus

Background Systemic corticosteroid therapy is known to lead to pituitary–adrenal (PA) suppression. Although patients treated for pemphigus with dexamethasone–cyclophosphamide pulse (DCP) therapy have shown no evidence of PA suppression, no study has been conducted to study this possible side‐effect of DCP therapy.