"I am on rituximab and steroids. Can I start EPOH?"
Yes. And you do not stop anything.
That is the whole answer, and everything below is the detail behind it. If you read no further: nothing about starting with us involves reducing, delaying, tapering, substituting or discontinuing a single drug your doctor has prescribed.
What "you do not stop" means, spelled out
Not the prednisolone. Not the rituximab schedule. Not the azathioprine, the mycophenolate mofetil, the methotrexate, the dapsone or the doxycycline. Not the potent topical steroid your dermatologist prescribed for your pemphigoid. Not the bone protection, the stomach protection, the diabetes drugs or the antibiotics.
We are not your prescribing doctor and we will not behave as though we are. We do not adjust doses. We do not write tapers. We do not tell you to "reduce slowly and see". Any change to your prescription is a decision for the doctor who prescribed it.
If anything you ever read or hear from us appears to say otherwise, it is wrong, and you should ignore it.
Why we are rigid about this — it is pharmacology, not politeness
- Abrupt steroid withdrawal after prolonged use can precipitate an adrenal crisis, because your own adrenal glands have stopped producing cortisol on demand. This can kill people. It is not a theoretical risk.
- Reducing immunosuppression in active pemphigus risks a severe flare of a disease that is dangerous and, untreated, can be life-threatening. Pemphigus vulgaris is not a condition on which to run an experiment with your only working treatment.
- Rituximab's effect is not something you can feel week to week. You cannot self-assess whether it is "still needed". Nobody can, from the outside.
A clinic willing to touch any of that from a distance, on the basis of an online consultation, is a clinic to walk away from — including if it were us.
What EPOH actually is, so you can assess the risk honestly
EPOH is entirely formulation-based: oral compounds and topical preparations, couriered to you and taken at home. There is no procedure, no in-clinic therapy, and no clinic visit at any stage.
That matters for the interaction question, because it means the only thing to assess is what you swallow and what you apply. There is nothing done to you, and you can stop on any day.
Interactions: the answer that is true rather than the one that sells
Herbal compounds are not inert, and "it's natural, so it's safe" is false. We will not say it and you should distrust anyone who does.
Anything taken by mouth can in principle affect the liver enzyme pathways that also metabolise your immunosuppressant, and can add to the metabolic load on a liver that is already processing azathioprine or methotrexate. That is a real consideration in a person on immunosuppression, and it is exactly why this is not something to improvise.
So, three requirements, and they are not negotiable:
1. Your dermatologist must know. Tell them you are taking Ayurvedic oral formulations and topical preparations. Not a vague mention — a clear statement, recorded in your notes. If you feel you would rather hide it from them, that instinct is worth examining: you should not be taking anything you feel you must conceal from the doctor managing a potentially life-threatening disease. No clinician treating you should be blind to what you are taking. Where a treating physician needs composition detail in order to assess an interaction, that is a legitimate clinical request and it is handled as one.
2. We need your full drug list. Names, doses, durations, and your rituximab dates. Not a summary — the list.
3. We need your recent bloods. Liver function, kidney function, full blood count, glucose. If your liver function is deranged, we adjust or we decline. Declining is a real outcome and we would rather do it than take your money.
Where EPOH sits against the treatment you are already on
The sequence is LIFES, and the sequence is the medicine:
- Phase L — Lowering Inflammatory Load
- Phase I — Internal Healing & Gut Repair
- Phase F — Functional Detox & Immune Balancing
- Phase E — External Care & Local Reversal (topical preparations you apply at home)
- Phase S — Sustaining Remission
Mapped onto where you probably are:
On high-dose steroid, disease still active. This is Phase L and Phase I territory. The steroid is doing the acute suppression — that is its job and it is good at it. The work we do in that window is on the systemic inflammatory load and the internal terrain, including a gut lining being damaged by the very drugs keeping you alive.
After rituximab, in the B-cell depleted window. Your disease is quiet, your dose is coming down, and you feel almost normal. This is the period people waste. It is the easiest window to tolerate the internal phases, and it is the last quiet stretch before the vulnerable one.
As B cells return and the taper proceeds. This is where relapse happens and where conventional medicine has least to offer beyond watching and re-treating. Phase S — Sustaining Remission — is aimed squarely at this window.
The rule that explains why people got hurt
Phase F, run before Phase L and Phase I are stable, mobilises internal load faster than the system can clear it — and the condition gets worse.
This is not a disclaimer. It is the single most common way people with blistering disease are harmed by Ayurvedic treatment. They walk in, and someone starts them on a "cleanse" or a "detox" in week one, because that is what the market expects Ayurveda to look like. They flare. They conclude that Ayurveda made them worse and never return.
They were right that they got worse. The timing was wrong, not the approach.
What we will not claim
- We will not tell you that EPOH lets you taper faster. Your taper is your dermatologist's decision, made on your clinical picture and your antibody titres. We have no trial data supporting a faster taper, and if we implied it we would be inventing it.
- We do not claim to clear the autoantibody. Rituximab is the drug aimed at the cells that make it.
- We do not promise a cure. We aim at sustained remission, as an adjunct, alongside conventional care and never instead of it.
- We cannot tell you in advance whether you will respond. We do not know.
The timeline, so you can hold us to it
The first four to eight weeks are internal work. Visible change on your skin is not expected in that window. From months two to four, the disease should begin to change. Stable remission is assessed from month eight onwards.
Measure it: new lesions per week, time for an erosion to close, itch out of ten, mucosal pain and ability to eat, and your antibody titre trend on repeat ELISA. If nothing has moved on any of those by month four, that is a signal — not an argument for buying more.
When we say no, or not yet
- Severe active mucosal disease where you cannot eat or swallow — that is your dermatologist, today, not us.
- Suspected infection or sepsis: fever, spreading redness, pus, feeling suddenly very unwell. Emergency care. Now.
- Significant liver or kidney impairment.
- Pregnancy, including pemphigoid gestationis — that belongs with your obstetric and dermatology team.
- Inherited epidermolysis bullosa. It is a genetic mutation, not an autoimmune disease. It is not reversible by any treatment, ours included.
- Anyone who wants to use us instead of their dermatologist. The answer there is simply no.
The question to ask any clinic, including this one
"What will you refuse to treat, and what would make you tell me to stop?" If they have no answer, leave.
