Therapeutic Effect Of Topical Glucocorticoid On Pemphigus And Its Mechanism

Objective: To evaluate the efficacy of topical glucocorticoids in pemphigus and explore the effect of long-term topical or systematic use of glucocorticoids on miceMethods: 1,64 patients with primary pemphigus and 23 patients with recurrent pemphigus from February 2016 to February 2020 were enrolled in this study.The patients’ age,course of disease,clinical type,affected site,skin lesion performance,severity score,antibody titer and dosage were evaluated to find the relationship between them and treatment effect.2,18 adult male C57 BL / 6 mice were divided into the external glucocorticoid group and the systemic glucocorticoid group randomly.The weight,fasting blood glucose,histopathological changes of heart,liver,spleen,lung and kidney,thymus index,spleen index,epidermis thickness,skin appearance,expression of glucocorticoid receptor were evaluated after 28 days to assess the influence between topical and system glucocorticoid.Results: In 64 cases of initial pemphigus,the treatment effect of erythema defoliate type was better than that of common type(P < 0.01).Dsg3 was related to the clinical effect,and the effective rate of patients with negative antibody was high(P < 0.001).What’s more,the treatment effect of patients without oral involvement was better than that of patients with oral involvement,which was also consistent with the clinical type(P< 0.01).In 23 cases of recurrent pemphigus,the efficacy of topical glucocorticoid was related to the degree of damage of PDAI at the time of recurrence,and the patients with lower degree of damage were more effective(P < 0.5).Moreover,the disease activity score of PDAI at the time of recurrence was also related to the efficacy,and the patients with low disease activity were more effective(P < 0.001).In our study,the effects of systemic glucocorticoid on weight,spleen index and spleen pathology were greater than that of topical glucocorticoid;the effects of topical glucocorticoid on thymus index and liver pathology were greater than that of system;the effects of epidermis thickness,hair growth and glucocorticoid receptor expression were similar.Conclusions: For initial pemphigus,PF is more suitable for topical glucocorticoids only,and the recurrent pemphigus patients with low severity patients is mor effective.Long-term high-dose topical glucocorticoids will also cause system metabolism,organ damage and gene expression in mice as system application.