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Finding a Way to Treat the Untreatable

Bella came into my life about 5-6 years ago having a very difficult autoimmune disease called Pemphigus Vulgaris. Often affecting the lining of the mouth first, the body attacks the bond that holds the epidermal cells together allowing them to slide apart. Similar to eroding mortar between bricks, fluid collects in the spaces and we get blisters. This condition occurs when antibodies are attacking and destroying the skin which can create erosions, blisters, ulcers, non-healing scars and ultimately can cause death.

Over the last 5 years I have cared very compassionately for Bella, but it has been very difficult to control her outbreaks. I have tried multiple treatment options including steroids, prednisone, and immunomodulating drugs like Imuran. However, I was never able to satisfactorily control her blistering.

A new group of medications called biologic agents were developed over the last decade and my attention was drawn to Rituximab. This biologic agent was successfully tested for treating Pemphigus Vulgaris.

This medication connected me to my Alma Mater. Professor Michael Hertl, Chairman of the Department of Dermatology at Philipps University in Marburg, Germany, has done significant research and published a large series of treatments with Rituximab. As I have a certain affinity to my Alma Mater, I reached out to Professor Hertl and connected with him. I visited him in July of 2016 and discussed the studies.

During this evolution, while treating Bella and my connection with Dr. Hertl, I realized how important it is to marry innovation, imagination, improvisation and implementation in our everyday life to deliver results for our patients. In summary, caring for Bella over the last several years I was able to give her only three doses of Rituximab every 16-18 months along with Tylenol, Benadryl and Hydrocortisone. Together this has been tremendously successful in suppressing the eruptions.

Today, I am very pleased to report that Bella has had the best response with this treatment and excellent interval findings. So let us all remember to always turn to innovation, imagination, improvisation and implementation and make a difference for our patients.

With my best wishes,

Panos Vasiloudes, MD, PhD

Board Certified Dermatologist, Board Certified Pediatrician

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