Objective — to increase the effectiveness of acantholytic pemphigus treatment taking into account the data of modern diagnostic methods, the use of cortisone therapy and prevention of complications after long­term use of glucocorticosteroid medications.
Materials and methods. 30 patients with acantholytic pemphigus aged from 51 till 72 years were under the observation; the duration of the disease was from 3 weeks to 3 months. Methods of investigation: general clinical, daily monitoring of arterial pressure, cardiointervalmetry with the device Cardiolab, oxidative modification of proteins, metabolism of nitric oxide. Four­time study was conducted: before the treatment, after 2—3 weeks of taking high doses of glucocorticosteroids (stage I), after 1.5—2 months of the therapy, when hormone doses were reduced (stage II) and 3—4 months after discharge from the hospital, when the patient received therapy with maintenance doses of hormones (Stage III). At the first stage of therapy, in addition to glucocorticosteroids, the use of two antihypertensive drugs, intravenous drip of rehambyrin, platelet aggregation inhibitors, probiotics, hepatoprotectors (Essentiale-H), ATP and cocarboxylase as intramuscular injection, sodium chloride solution iv, antibiotics, potassium preparations, calcium, antacids. At the second stage, patients received the same drugs, but in slightly reduced doses, one antihypertensive drug, hepabene was prescribed from hepatoprotectors. At the third stage, it is necessary to use antihypertensives (Аmlodipine), diuretics (Triphas), hepatoprotectors, anticoagulants, vitamins, potassium preparations. At this stage, we recommend taking statins (Roxera).
Results and discussion. Patients with acantholytic pemphigus had a statistically significant increase of glucose values, AlAt, AsAt, cholesterol, especially LNSH, triglycerides, a decrease in total protein. In the future, at all stages of treatment, the tendency to normalization was noted, but only triglycerides, LDL cholesterol, glucose, total protein demonstrated full correction at the third stage. When studying the variability of the heart rate, we revealed pathological changes in the vegetative balance towards sympathotonia, which were multidirectional at different stages of treatment. During the 24-hour monitoring of arterial pressure, an increase of patients with an insufficient nightly fall of non dippers pressure over CAT was found, and an increase in patients with non dippers and night peakers before treatment. The study of oxidative modification of proteins has established a high level of endogenous intoxication in patients with AP, even at the third stage of treatment. While studying the metabolism of NO in patients with AP before the treatment, a high level of NO synthase was established, which caused pathological effects of NO, and during the treatment with hormones its level droped sharply, especially at the third stage.
Conclusions. Therapy of patients with AP should be performed in 3 stages depending on the doses of glucocorticosteroids using both traditional drugs and some new ones, based on the study of liver function, biochemical parameters, heart rate variability, monitoring of blood pressure, metabolism of NO, oxidative modification of proteins. The administration of anabolic and sedatives is not recommended.

Keywords: pemphigus, biochemistry, protein, NO-­synthase, treatment, preparations, glucocorticosteroids, stages.