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REVIEW ARTICLE
ABSTRACT
Steroids pulse therapies are used in inflammatory and autoimmune conditions as they are cumulatively less toxic. Pulse therapy is
the administration of supra therapeutic administration of steroids in intermittent manner. This form of therapy has given excellent
treatment response with very few side-effects. Various modifications of steroid pulse therapies have been tried in pemphigus, alopecia,
vitiligo etc., successfully.
Key Words: Dexamethasone-cyclophosphamide pulse therapy, pulse therapy, steroid
Various modifications and modes are in use. Most Administration of Pulse Therapy
commonly used corticosteroids in pulse therapies are Initially, the duration of infusion was 10-20 min. However,
methylprednisolone and dexamethasone.[6] rapid infusions are known to be associated with a higher
risk of hemodynamic abnormalities, now-a-days the
Methylprednisolone Pulse Therapy corticosteroid preparation is dissolved in 150-200 ml of
Methylprednisolone is an intermediate acting, potent, 5% dextrose and infused IV, slowly over 2-3 h.[8,10]
anti-inflammatory agent with a low tendency to
induce sodium and water retention compared with Advantage of Corticosteroid as a Pulse Therapy
1. An immediate profound anti-inflammatory effect is
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achieved and the toxicities seen with conventional
Quick Response Code
Website:
Department of Dermatology, SDM Medical College, Sattur, Dharwad,
www.mjmsr.net
Karnataka, India
Address of correspondence: Dr. Gaurang Gupta, Department of
DOI: Dermatology, OPD No. 10, SDM Medical College, Sattur,
10.4103/0975-9727.135756 Dharwad - 580 009, Karnataka, India.
E-mail: manavgups@gmail.com
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high dose oral therapy are low. Faster clinical Laboratory Monitoring
recovery from symptoms than with oral therapy, the
Before Starting the Therapy
clinical improvement is seen to last about 3 weeks
after one pulse. As a routine, it is mandatory to admit every patient
2. No prolonged suppressive effect on the hypothalamic- enrolled for pulse therapy. Hemogram, serum electrolytes,
pituitary axis.[8-10] renal and liver function tests, blood sugar (including
hemoglobin A1c), urine microscopic examination, chest
Mechanism of Action X-ray, electrocardiogram and pregnancy test are some
of the preliminary laboratory tests to be done at the first
Glucocorticoids exert a variety of immunosuppressive,
visit. Blood sugar, serum electrolytes, urine microscopic
anti-inflammatory and anti-allergic effects. They mediate
examination, body weight and blood pressure should be
their actions through genomic and non-genomic
monitored at baseline and at each visit of the patient.[14]
methods.[7] Buttgereit et al. have postulated 3 “modules”
of glucocorticoid effect on cells resulting from different
During and Following Therapy
concentrations:[11]
1. Low concentrations mediate effects via genomic Careful record of heart rate, respiratory rate and blood
events. pressure every 15-30 min should be maintained. If an
2. Medium concentrations bind to cell surface receptors, arrhythmia is suspected, the infusion is discontinued; an
which activate cross membrane signal transmission electro cardiogram and blood levels of sodium, potassium,
for genomic and non-genomic intracellular events. calcium and magnesium are obtained and abnormalities
3. At very large concentrations steroids dissolve in are rectified. Careful screening for occurrence or
the cell membrane resulting in greater membrane exacerbation of infections should be done. Estimate blood
stability and reduced non-genomic cell function. levels of sugar and electrolytes every other day.[13]
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some sever and chronic disease of dermatology such blockade in rheumatoid arthritis: Comment on the article by Taylor
et al. Arthritis Rheum 2001;44:245-6.
as pemphigus, erythroderma, TEN/SJS etc.
13. Sinha A, Bagga A. Pulse steroid therapy. Indian J Pediatr
2008;75:1057-66.
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Scand J Rheumatol 2005;34:14-21. How to cite this article: Gupta G, Jain A, Narayanasetty NK. Steroid
pulse therapies in dermatology. Muller J Med Sci Res 2014;5:155-8.
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Source of Support: Nil, Conflict of Interest: None declared.
effects of pulse corticosteroid and tumor necrosis factor alpha
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