A Study on the Efficacy and Adverse Effects of Immunosuppressant Drugs in Chronic Skin Diseases

AIM: Chronic skin diseases include autoimmune diseases like psoriasis, pemphigus vulgaris and systemic sclerosis which require long term drug therapy. The present study was undertaken to monitor the efficacy and adverse effects of immunosuppressant drugs used in chronic skin diseases. MATERIALS AND METHODS: 80 newly diagnosed chronic skin diseases patients were included for the study after obtaining ethical clearance. They were started on Methotrexate, Dexamethasone - Cyclophosphamide pulse therapy, Azathioprine, folic acid, calcium and antiulcer agents. Response was assessed by at the end of first, third and sixth month of therapy. In patients with psoriasis the treatment efficacy was monitored by Psoriasis Area Severity Index (PASI) score. In patients with pemphigus vulgaris the treatment efficacy was monitored by Pemphigus Area and Activity Score (PAAS) and in patients with systemic sclerosis the treatment efficacy was monitored by modified Rodnan’s skin scores (MRSS). Tolerability was assessed by haematological and clinical examinations. RESULTS: Of 80 patients who completed the study 45% were males and 55% were females. The mean age of diagnosis was 38.69 ± 10.67 years. There was statistically significant (p< 0.0001) reduction in the PASI Score, PAAS, MRSS at the end of first, third and sixth month of therapy, which showed better response to drug therapy. The adverse effects observed in the study are nausea, vomiting, gastritis, microcytic anaemia and others. These adverse effects were managed by anti emetics, proton pump inhibitors, folic acid, iron supplementation and calcium. CONCLUSION: From this study we conclude that extensive use of conventional daily steroids often results in disabling and life threatening adverse effects. The concomitant uses of immunosuppressant drugs like methotrexate, dexamethasone – cyclophosphamide pulse therapy were well tolerated and efficacious in autoimmune skin diseases

Progressive Multifocal Leukoencephalopathy: Current Insights

Cases of PML should be evaluated according to predisposing factors, as these subgroups differ by incidence rate, clinical course, and prognosis. The three most significant groups at risk of PML are patients with hematological malignancies mostly previously treated with immunotherapies but also untreated, patients with HIV infection, and patients using monoclonal antibody (mAb) treatments. Epidemiological data is scarce and partly conflicting, but the distribution of the subgroups appears to have changed. While there is no specific anti-JCPyV treatment, restoration of the immune function is the most effective approach to PML treatment. Research is warranted to determine whether immune checkpoint inhibitors could benefit certain PML subgroups. There are no systematic national or international records of PML diagnoses or a risk stratification algorithm, except for MS patients receiving natalizumab (NTZ). These are needed to improve PML risk assessment and to tailor better prevention strategies