Patients with recalcitrant pemphigus may respond to ultra-low-dose rituximab, dermatologists say.

Six of eight patients treated at Royal Melbourne Hospital responded to two off-label 200mg doses, given a fortnight apart, with clinically significant reduced disease activity at six months, they report.

In a research letter to the British Journal of Dermatology, the doctors retrospectively reviewed the cases, all of whom had either recalcitrant disease or contraindications to traditional immunosuppressants.

At baseline, patients had a Pemphigus Disease Area Index (PDAI) of between four and 20 (range 0 to 263, higher worse).