Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 75, Num. 5, 2009, pp. 511-511

Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 5, September-October, 2009, pp. 511

Letter to the Editor

Dexamethasome-cyclophosphamide pulse therapy for systemic sclerosis

Ramji Gupta

Pemphigus and Pulse Therapy Foundation, New Delhi, India

Correspondence Address: Dr. Ramji Gupta, M-54, Jal Vihar Road, Lajpat Nagar-II, New Delhi - 110054, India
drramjigupta@yahoo.co.in

Code Number: dv09162

PMID: 19736436

DOI: 10.4103/0378-6323.55400

Sir,

This is in reference to the article 'Therapeutic trials for systemic sclerosis: An update' by Sardana and Garg . ^[1] The comprehensive review needs the following references ^{[2],[3],[4],[5],[6],[7],[8]} to be added.

It may also be added that as many as 14 dermatologists in various institutions have used dexamethasone cyclophosphamide pulse therapy (DCP)/dexamethasone pulse therapy (DP) regimen for about 300 systemic sclerosis patients ^[8] and found satisfactory recoveries. DCP therapy consists of transfusing 100 mg dexamethasone dissolved in 500 ml 5% glucose over one to two hours, for three consecutive days every month, along with cyclophosphamide 500 mg on day one in the same drip and 50 mg daily, orally, in between the pulses. In DP only dexamethasone 100 mg is transfused in 500 ml 5% glucose over one to two hours for three consecutive days every month. It is used in those patients where cyclophosphamide is contraindicated.

For the information of the dermatologists, DCP / DC is able to bring about a total/almost total reversal of the changes, including skin hardening, pigmentary changes, arthritis, dysphagia, dyspnea to a variable extent, gangrene, fingertip ulceration, and even Raynand's phenomenon, which are commonly observed in progressive systemic sclerosis patients. The total treatment is to be given for three to four years. Less doses as used by those who have found unsatisfactory results, are obviously due to inadequate treatment.^[9]

References

1.	Sardana K, Garg VK. Therapeutic trials for systemic sclerosis: An update. Indian J Dermatol Venerol Leprol 2008;74:436-46.  Back to cited text no. 1
2.	Pasricha JS, Ramam M, Shah S. Reversal of systemic sclerosis with dexamethasone pulses. Indian J Dermatol Venereol Leprol 1990; 56: 40-42.   Back to cited text no. 2
3.	Pai BS, Srinivas CR, Sabitha L, Shenoi SD, Balachandran CN, Acharya S. Efficacy of dexamethasone pulse therapy in progressive systemic sclerosis. Int J Dermatol 1995;34:726-8.  Back to cited text no. 3  [PUBMED]
4.	Vatwani V, Palta SC, Verma N, Pathak PR, Singh RP. Pulse therapy in scleroderma. Indian Pediatr 1994;31:993-5.  Back to cited text no. 4  [PUBMED]
5.	Dalal M, Balachandran C, Sabitha L. Monthly dexamethasone pulse therapy in systemic sclerosis. A clinic evaluation. Abstract 27 th IADVL Conference 1999. p. 87.  Back to cited text no. 5
6.	Sharda B, Kumar A, Kakker R, Adya CM, Pande I, Uppal SS, et al Intravenous dexamethasone pulse therapy in diffuse systemic sclerosis: A randomized placebo controlled study. Rheumatol Int 1994;14:91-4.  Back to cited text no. 6
7.	Khaitan BK, Gupta S. Systemic sclerosis successfully treated with dexamethasone pulse therapy. Dermascan 1999;1:9-11.  Back to cited text no. 7
8.	Gupta R. Systemic sclerosis treated with dexamethasone pulse therapy. Indian J Dermatol Venereol Leprol 2003;69:191-2.  Back to cited text no. 8  [PUBMED]
9.	Ramam M, Bhat R. Pulse therapy in other diseases. In: Pasricha JS editor. Pulse therapy in pemphigus and other diseases. 3 rd ed. New Delhi: Mehta Publishers; 2006. p. 91-5.  Back to cited text no. 9

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