Rituximab is a B-cell antibody treatment option for patients with pemphigus that is being used as first line therapy by many clinicians. In March 2017, the FDA granted breakthrough therapy designation for rituximab. How does it work? B-cells are responsible for producing antibodies for the body, rituximab works as an immunosuppressant that destroys B-cells of the immune system. A course of rituximab is administered with the hope that it will destroy all the B-cells that make antibodies in pemphigus or pemphigoid are removed. Retreatment with rituxan may be required, usually at six months or longer after the initial treatment.
Meshkinpour et al (2005) examined the safety and effectiveness of the ThermaCool TC radiofrequency system for treatment of hypertrophic and keloid scars and assessed treatment associated collagen changes. Six subjects with hypertrophic and 4 with keloid scars were treated with the ThermaCool device: 1/3 of the scar received no treatment (control), 1/3 received one treatment and 1/3 received 2 treatments (4-week interval). Scars were graded before and then 12 and 24 weeks after treatment on symptoms, pigmentation, vascularity, pliability, and height. Biopsies were taken from 4 subjects with hypertrophic scars and evaluated with hematoxylin and eosin (H & E) staining, multi-photon microscopy, and pro-collagen I and III immunohistochemistry. No adverse treatment effects occurred. Clinical and H & E evaluation revealed no significant differences between control and treatment sites. Differences in collagen morphology were detected in some subjects. Increased collagen production (type III > type I) was observed, appeared to peak between 6 and 10 weeks post-treatment and had not returned to baseline even after 12 weeks. The authors concluded that use of the thermage radiofrequency device on hypertrophic scars resulted in collagen fibril morphology and production changes. ThermaCool alone did not achieve clinical hypertrophic scar or keloid improvement. They noted that the collagen effects of this device should be studied further to optimize its therapeutic potential for all indications.
Treatment is difficult. Due to the intensity of the itch patients often go from doctor to doctor looking for relief. No one treatment is always effective and several treatments may need to be tried. Initial treatment is often potent prescription steroid creams . If these help, a milder cream can be used for longer-term control. Antihistamine creams (Zonalon, Pramoxine) or pills (Atarax, Periactin) are often added for additional relief. Intralesional steroid injections , anti-depressant pills, and non-prescription capsaicin cream helps many of those not improved with the usual treatment.