Paul M A, Jorizzo J L, Fleischer A B, White W L
Department of Dermatology, Wake Forest University Medical Center, Winston-Salem, North Carolina.
J Am Acad Dermatol. 1994 Oct;31(4):620-5. doi: 10.1016/s0190-9622(94)70227-6.
Various treatments have been used for elderly patients with bullous pemphigoid. The most common is moderate-dose to high-dose prednisone, either alone or in combination with other oral or topical agents.
The aim of this study was to evaluate the efficacy of low-dose methotrexate as a steroid-sparing agent in patients with bullous pemphigoid. METHODS. A retrospective chart review of 34 patients with bullous pemphigoid seen from 1989 through the first half of 1993 was conducted. The diagnosis of bullous pemphigoid was confirmed by direct or indirect immunofluorescence microscopy, or salt-split skin sections. Eight of 34 elderly (> 60 years old) patients with therapy-resistant bullous pemphigoid received low-dose weekly methotrexate (average, 5 to 10 mg) in combination with oral prednisone.
Patients who received combination therapy required significantly lower (p < or = 0.02) doses of prednisone to control their disease at 1 month compared with baseline doses.
In this elderly patient population the side effect profile of the methotrexate was acceptable and well tolerated. We therefore recommend methotrexate and low-dose corticosteroid as first-line combination therapy for selected elderly patients with bullous pemphigoid.
已对大疱性类天疱疮老年患者采用了多种治疗方法。最常用的是中等剂量至高剂量的泼尼松，单独使用或与其他口服或外用药物联合使用。
本研究旨在评估低剂量甲氨蝶呤作为大疱性类天疱疮患者的类固醇节约剂的疗效。方法。对1989年至1993年上半年就诊的34例大疱性类天疱疮患者进行了回顾性病历审查。大疱性类天疱疮的诊断通过直接或间接免疫荧光显微镜检查或盐裂皮肤切片得以证实。34例老年（>60岁）治疗抵抗性大疱性类天疱疮患者中的8例接受了低剂量每周一次的甲氨蝶呤（平均5至10毫克）联合口服泼尼松治疗。
与基线剂量相比，接受联合治疗的患者在1个月时控制病情所需的泼尼松剂量显著更低（p≤0.02）。
在这一老年患者群体中，甲氨蝶呤的副作用情况是可接受的且耐受性良好。因此，我们推荐甲氨蝶呤和低剂量皮质类固醇作为部分老年大疱性类天疱疮患者的一线联合治疗方案。
