No controlled studies have tested the hypothesis that gold is an effective therapy for treatment of pemphigus. The largest and most recent case series, by Pandya and Dyke,38 described 26 patients treated with gold, either alone or in combination with prednisone. Patients with severe disease requiring "aggressive" therapy and patients that had experienced "severe complications from steroid use" were excluded from the study. Eleven patients (42%) were able to discontinue steroids, seven of whom still required gold. The duration of gold therapy required before steroid dosages could be tapered was 3 months. There was no mortality, but toxic effects were noted in 11 patients, nine of whom discontinued therapy. Thus, a high percentage of patients improved during the study, but many were forced to discontinue the therapy because of toxic effects.

Similar results were reported by Poulin et al39 Thirteen patients, whose disease severity was not described, were treated with gold and prednisone. Three patients also received either dapsone or sulfapyridine. Seven patients (54%) experienced complete remission and one patient (8%) died. Gold therapy had to be discontinued in five patients (38%) because of toxic effects.

Because there are no controlled trials of gold therapy in pemphigus, it is difficult to determine whether the observed clinical improvement of patients receiving gold and steroids are, in fact, gold induced. Overall rates of remission and mortality reported for patients treated with gold and steroids are similar to rates that have been reported for patients treated with steroids alone or in combination with immunosuppressive agents.3 Although side-effects related to gold therapy are often minor, a substantial proportion of patients are unable to tolerate treatment.

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