PMID- 34984113
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220107
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 11
DP  - 2021 Nov
TI  - Combination Therapy of Plasma Exchange and Rituximab to Treat Cicatricial 
      Pemphigoid and Bullous Pemphigoid.
PG  - e19932
LID - 10.7759/cureus.19932 [doi]
LID - e19932
AB  - The pemphigoid group of subepidermal autoimmune blistering diseases can affect 
      both cutaneous and mucosal tissues. Therapy of this group of diseases, including 
      cicatricial pemphigoid (CP) and bullous pemphigoid (BP), consists of systemic 
      steroids and immunomodulatory agents. Recalcitrant cases have typically been 
      treated with plasmapheresis or rituximab individually. This report describes two 
      patients with severe, rapidly progressive CP and BP refractory to high-dosage 
      systemic steroids and immunomodulatory agents. Both patients were treated with a 
      combination of plasmapheresis and rituximab. In addition to these cases, one 
      retrospective study showed the effectiveness of other immunosuppressants in 
      combination with plasmapheresis in 17 patients with pemphigus refractory to 
      corticosteroids and immunosuppressants alone. No major adverse events occurred in 
      the study. Similar studies employing immunoadsorption and rituximab with various 
      combinations of intravenous immune globulin (IVIg), corticosteroids, and other 
      conventional immunosuppressants have shown promising results in other autoimmune 
      blistering diseases. The successful response in the patients described here, as 
      well as those described in the literature who underwent similar management, 
      provides a possible combination treatment option for patients with severe, 
      recalcitrant pemphigoid. A further trial with a larger group of pemphigoid 
      patients is warranted.
CI  - Copyright (c) 2021, Kunadia et al.
FAU - Kunadia, Anuj
AU  - Kunadia A
AD  - Dermatology, University of Central Florida College of Medicine, Orlando, USA.
FAU - Sami, Naveed
AU  - Sami N
AD  - Dermatology, University of Central Florida College of Medicine, Orlando, USA.
LA  - eng
PT  - Case Reports
DEP - 20211127
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8713951
OTO - NOTNLM
OT  - autoimmune blistering diseases
OT  - bullous pemphigoid
OT  - cicatricial pemphigoid
OT  - plasma exchange
OT  - rituximab
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/01/06 06:00
MHDA- 2022/01/06 06:01
PMCR- 2021/11/27
CRDT- 2022/01/05 05:56
PHST- 2021/09/11 00:00 [received]
PHST- 2021/11/27 00:00 [accepted]
PHST- 2022/01/05 05:56 [entrez]
PHST- 2022/01/06 06:00 [pubmed]
PHST- 2022/01/06 06:01 [medline]
PHST- 2021/11/27 00:00 [pmc-release]
AID - 10.7759/cureus.19932 [doi]
PST - epublish
SO  - Cureus. 2021 Nov 27;13(11):e19932. doi: 10.7759/cureus.19932. eCollection 2021 
      Nov.