From the Guidelines
Yes, pemphigus vulgaris can occur initially in patients who are 77 years old. While pemphigus vulgaris typically has its peak incidence between 40-60 years of age, it can develop at any age, including in elderly individuals [ 1 ]. In fact, some studies suggest a bimodal age distribution with a second peak in the elderly population. When diagnosed in older patients, treatment considerations may need to be adjusted due to potential comorbidities and increased risk of medication side effects.
Key Considerations
- The standard treatment approach still includes systemic corticosteroids (such as prednisone 1 mg/kg/day) as first-line therapy, often combined with steroid-sparing immunosuppressants like azathioprine (2–3 mg kg-1 per day) or mycophenolate mofetil (2–3 g per day) [ 1 ].
- Rituximab may also be considered, particularly in cases resistant to conventional therapy [ 1 ].
- Elderly patients require careful monitoring for side effects, especially infection risk, bone density changes, and metabolic complications.
Treatment Approach
The treatment approach for pemphigus vulgaris in elderly patients should be individualized, taking into account the patient's overall health status, comorbidities, and potential risks associated with treatment.
- First-line therapy: Corticosteroids, such as oral prednisolone, with an optimal dose not established but suggesting start with prednisolone 1 mg kg-1 per day (or equivalent) in most cases, 0.5–1 mg kg-1 in milder cases [ 1 ].
- Adjuvant immunosuppressant: Combine corticosteroids with an adjuvant immunosuppressant, such as azathioprine (2–3 mg kg-1 per day) or mycophenolate mofetil (2–3 g per day) [ 1 ].
- Monitoring and adjustment: Regular monitoring of the patient's response to treatment and adjustment of the treatment regimen as needed to minimize side effects and optimize outcomes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pemphigus Vulgaris Occurrence
- Pemphigus vulgaris is a chronic, autoimmune, vesiculobullous disease that can occur at any age, but the provided studies do not specifically mention the occurrence of pemphigus vulgaris in a 77-year-old patient as an initial case.
- The studies focus on the management and treatment of pemphigus vulgaris, including the use of corticosteroids, immunosuppressive agents, and rituximab 2, 3, 4, 5.
- The etiology and pathogenesis of pemphigus vulgaris are discussed in one study, which highlights the importance of genetic predisposition and environmental triggering factors, but does not provide information on the age of onset 6.
Age of Onset
- There is no specific information in the provided studies about the age of onset of pemphigus vulgaris, particularly in relation to a 77-year-old patient.
- The studies provide general information on the management and treatment of pemphigus vulgaris, but do not address the question of whether pemphigus vulgaris can occur initially in a patient at the age of 77.
Treatment and Management
- The treatment and management of pemphigus vulgaris are discussed in several studies, which highlight the importance of early diagnosis, early initiation of treatment, and the use of steroid-sparing adjuvants to reduce the total dose and duration of corticosteroids 2, 3, 4, 5.
- The studies provide information on the use of corticosteroids, immunosuppressive agents, and rituximab in the treatment of pemphigus vulgaris, but do not address the specific question of whether pemphigus vulgaris can occur initially in a patient at the age of 77.