Pulse corticosteroid therapy has been used for the treatment of various dermatologic diseases. Most of the data generated from the use of pulse steroids to treat dermatologic diseases has been from studies with a limited number of patients. Further data relating the complications and clinical experience with the use of pulse corticosteroids in dermatology is needed. Our purpose was to review our 4-year experience with patients who had received pulse corticosteroids alone or in conjunction with cyclophosphamide at our inpatient service. Particular attention was given to the complications encountered and response to therapy. The medical records of patients who received pulse steroids at our center were reviewed with respect to patient demographics, clinical response and complications of therapy. During a period of 4 years, 38 patients received pulse corticosteroids alone and 4 received them in combination with cyclophosphamide. The conditions treated were: pyoderma gangrenosum, pemphigus vulgaris and foliaceus, systemic sclerosis, hidradenitis suppurativa, eosinophilic fasciitis, palmar fasciitis, systemic lupus erythematosus, polyarteritis nodosa, eosinophilia myalgia syndrome and a perianal ulcer associated with Crohn's disease. Of the 38 patients treated with pulse steroids alone, 30 (79%) responded favorably to therapy. On follow-up for 30 of these patients, 8 were in remission, 11 had improved but had experienced at least one recurrence and 11 experienced either no change in their condition or returned to their original condition. The most frequent complication was hyperglycemia (29 of 42 patients) and hypertension (12 of 42 patients). However, these complications were transient, and therapy was otherwise well tolerated. Our findings suggest that pulse corticosteroid therapy is efficacious and relatively safe. Careful monitoring of cardiovascular, respiratory, renal and electrolyte status should be performed and inpatient treatment is recommended.
