Turkderm-Turk Arch Dermatol Venereol. 2008; 42(1): 13-14

Pemfigus Hastalarýnýn Takibi: Klinik Remisyon, Tedavinin Sonlandýrýlmasý ve Klinik Deneyimimiz

Mukaddes Kavala, Ýlkin Zindancý
Saðlýk Bakanlýðý Göztepe Eðitim Ve Araþtýrma Hastanesi Deri ve Zührevi Hastalýklar Kliniði, Ýstanbul, Türkiye

Pemfigus tedavisinde amaç erken taný ve uygun ilaçlar ile uzun süreli remisyon saðlamak ve tedaviyi kesebilmektir. Tedavi etkinliðinin en iyi göstergesi mortalite ve remisyon süresidir. Pemfiguslu hastalarda görülen kýsmi veya tam ve uzun süreli remisyonu deðerlendiren belirli kriterlerin yokluðu tedaviyi sonlandýrmaya karar vermeyi zorlaþtýrmaktadýr. Hastalar aktif dönemde iken doz azaltmada ana parametre olarak klinik yanýt kullanýlýrken, klinik remisyonda immünolojik durumu gösteren direkt immünfloresan test (DIF) kullanýlýr. Negatif DIF bulgusu immünolojik remisyonun göstergesi olduðundan DIF testi negatif olan hastalarda hastalar uzun süre izlenmek üzere tedavi sonlandýrýlabilir. Kliniðimizde takip edilen 88 pemfiguslu hasta klinik remisyon ve immünolojik aktivite açýsýndan deðerlendirildiðinde IIF’nin 34 hastada pozitif olduðu görüldü. Klinik remisyondaki 54 hastanýn 26’sýnda DIF negatif, 28’inde pozitif bulundu. DIF sonucu negatif olan hastalarýn tedavisi kesilirken, pozitif olan hastalarda tedaviye devam edildi. DIF’i negatif olan 26 hastanýn 6’sýnda relaps görüldü.

Anahtar Kelimeler: Pemfigus, direkt immünfloresan, indirekt immünfloresan, klinik remisyon

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The Management of Pemphigus Patients: Clinical Remission, Discontinuation of Therapy and Our Experience

Mukaddes Kavala, Ýlkin Zindancý
Saðlýk Bakanlýðý Göztepe Eðitim Ve Araþtýrma Hastanesi Dermatoloji Kliniði, Ýstanbul, Turkey

The goal of therapy in pemphigus patients is to control the disease with appropriate medication and to discontinue the treatment. The best indicator of the treatment efficiency is mortality and the lenght of clinical remission.Because of the lack of reliable criteria to evaluate the partial or complete and sustained remission seen in pemphigus patients,it is difficult to decide the withdrawal of their drugs. When patýents are in the active phase of the disease the main parameter for reducing the dose of drugs is clinical response When the patient is in clinical remission direct immunofluorescence test (DIF ),valuable in the management of the disease, is used. Since a negative DIF finding implies immunologic remision of the disease, therapy can be discontinued in patients with negative results of DIF after a long period of clinical remission. In our series, 88 patients with pemphigus were examined for clinical remission and immunological activity. The indirect imunofluorescence (IIF) was positive in 34 patients. 54 patients who were in clinical remission, 26 patients had negative and 28 patients had positive results of DIF. Patients with negative results of DIF had their medications discontinued while patients with positive results continued their therapy. During the follow up period, 6 of 26 patients with negative DIF relapsed.

Keywords: Pemphigus, direct immunofluorescence, indýrect imunofluorescence, clinical remission

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ATIF KOPYALA