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Although the scalp can be frequently involved with pemphigus/pemphigoid, associated hair loss has only rarely been described. In one case, treatment with oral and topical corticosteroids combined with mycophenolate mofetil resulted in clinical remission, with regrowth of scalp hair. (1)

The main connection between prednisone and hair loss seems to be that, as a side effect of using of the drug, some users have complained of thinning hair.  High doses of the drug can make hair more brittle. This brittleness can make hair more fragile and increase shedding and breakage. Hair thinning may become more severe in individuals taking prednisone who also choose to use a chemical process on their hair such as hair dye or a perm. (2)

The connection between prednisone and hair loss is still being explored.  If you are experiencing hair loss, it is best to discuss with your dermatologist and a change in dosage or the use of additional medications may be used to help avoid this side effect.

I do know of one patient who experienced patches of hair loss.  She wore baseball caps all the time.  It did take a few years, but as she tapered off of her medications, her hair did grow back.  There is no timetable for this as each patient has a different level of antibody activity.  However, do not give up hope.  The hair will return.

(1)      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927177/

(2)     http://www.wisegeek.org/what-is-the-connection-between-prednisone-and-hair-loss.htm

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Pemphigus is a chronic, muco-cutaneous autoimmune blistering disorder; two main variants being pemphigus vulgaris (PV) and pemphigus foliaceus (PF). PV is the most common subtype, varying between 75 to 92% of total pemphigus patients. Although no community based studies are undertaken to estimate the incidence of pemphigus in India, it is relatively common. A questionnaire based survey in Thrissur district of south India estimated pemphigus incidence to be 4.4 per million population. Mortality due to pemphigus has decreased remarkably with the aggressive and widespread use of corticosteroids, prior to which it was as high as 90%. High dose corticosteroids were once used in combination with other immunosuppressants with good improvement, but such high doses of corticosteroids were often associated with severe side effects, and were responsible for the death of nearly 10% of the patients. With the aim of reducing the adverse effects of long term, high dose steroid administration dexamethasone cyclophosphamide pulse (DCP) therapy was introduced in 1984. Since then DCP or oral corticosteroids with or without adjuvant immunosuppressants (azathioprine, cyclophosphamide, mycophenolatemofetil, and cyclosporine) have been the corner-stone of therapy for these disorders in India. Despite the benefits associated with DCP therapy compared to high dose oral steroids, it cannot be denied that even DCP therapy with or without adjuvants can lead to numerous adverse events, which account for majority of deaths in pemphigus. Moreover there are few patients who fail to improve with these conventional treatments or have contraindications for their usage. Thus there has been a constant search for newer therapeutic modalities in pemphigus. Rituximab (Reditux. Dr. Reddy’s, Hyderabad, India and MabThera TM , Roche, Basel, Switzerland), a monoclonal chimeric IgG1 antibody targeting the B cell specific cell-surface antigen CD20, is one such newer novel therapy for pemphigus (an off-label indication for its use. It has so far been approved by FDA for use only in CD 20+ B cell non-Hodgkin’s lymphoma, treatment resistant rheumatoid arthritis, Wegener’s granulomatosis and microscopic polyangiitis).

There is currently no consensus on the optimal dosage and schedule of rituximab in treatment of pemphigus. The various treatment protocols followed include:

  1. Lymphoma protocol- Most commonly followed protocol. Rituximab is administered at a dose of 375mg/m 2 body surface area weekly for four weeks.
  2. Rheumatoid arthritis protocol- Two doses of rituximab 1g is administered at an interval of 15 days. Increasingly used by dermatologists and is the protocol currently followed in our institute. Advantage over the lymphoma protocol include less cost and fewer infusions.
  3. Combination therapy- Rituximab has been used in combination with IVIG, immunoadsorption and dexamethasone pulse therapy
  4. Long-term rituximab treatment with regular infusions every 4 or 12 weeks following an induction cycle of infusions every week

Full article can be viewed at: http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=6;spage=671;epage=676;aulast=Kanwar

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By Jay Glaser, M.D.

Dr. Glaser is a board-certified internist, researcher and medical director at the Lancaster Ayurveda Medical Centers based in Sterling, MA. He can be reached at 978-422-5044. Answers to many questions about Ayurveda can be found on the Lancaster web site, www.AyurvedaMed.com, where you can subscribe to their free online newsletter, The Spirit of Health.

Sufferers of pemphigus are in a good position to aid well meaning administrators in politics, social policy, security, intelligence and defense who are currently grappling with how to re-engineer a free society immune to disruption from within or without, because this disorder recapitulates issues in domestic security. Understanding the immunology of autoimmune disorders sheds light on critical issues of individual and societal health, so we will examine immunology from both a western and eastern perspective.