Treatment, which aims at reducing signs and symptoms and preventing complications, is generally more effective when it begins as early as possible. Treatment includes medications, and sometimes, hospitalization.
Medications may be used alone or in combination with each other to treat pemphigus. Commonly prescribed drugs include:
- Corticosteroids. The mainstay of treatment is usually corticosteroids, such as prednisone. However, using corticosteroids over an extended time or in high doses may cause serious side effects, including increased blood sugar, bone loss, an increased risk of infection, water retention, cataracts, glaucoma and a redistribution of body fat, leading to a round face (moon face).
- Immunosuppressants. These medications, such as azathioprine (Imuran), methotrexate (Trexall) or mycophenolate mofetil (CellCept), help keep your immune system from attacking healthy tissue. These drugs may have serious side effects, including increased risk of infection.
- Biological therapies. If other medications don't help ease your symptoms, or if you have difficulty taking other medications, your doctor may prescribe a newer type of drug called rituximab (Rituxan). Rituximab targets the white blood cells responsible for the production of the pemphigus antibodies.
- Antibiotics, antivirals and antifungal medications. These may be prescribed to control or prevent infections, particularly infection from staphylococcus bacteria or herpes viruses.
Additionally, other medications that alter the immune system, such as dapsone and intravenous immunoglobulin, may be prescribed.
If your pemphigus isn't too widespread, you can usually stay at home for treatment. But, widespread pemphigus may require you to stay in the hospital. The open sores make you highly vulnerable to infection, which, if it spreads to your bloodstream, can be fatal. Along with the medications listed above, you may be given:
- Fluids. Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — and proteins.
- Intravenous feeding. This may be necessary if mouth sores make it too painful for you to eat.
- Anesthetic mouth lozenges. These can help control pain of mild to moderate mouth sores.
- Therapeutic plasmapheresis. In this process, the fluid part of your blood, called plasma, is removed from blood cells by a device known as a cell separator. The purpose is to get rid of the antibodies that are attacking your skin. The plasma is replaced with donated plasma or intravenous fluids.
In about one-third of cases, treatment makes all of the blisters and sores disappear completely, and treatment can be stopped. Others take a lower dose of the medications indefinitely or their signs and symptoms will return.
Nov. 07, 2012
- Goldstein BG. Pemphigus. http://www.uptodate.com/index. Accessed Sept. 10, 2012.
- McPhee SJ, et al., eds. Current Medical Diagnosis and Treatment 2013. New York, N.Y.: McGraw-Hill Medical; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed September 12, 2012.
- Martin LK, et al. Interventions for pemphigus vulgaris and pemphigus foliaceus. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006263.pub2/abstract. Accessed Sept. 12, 2012.
- Pemphigus. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/health_info/pemphigus/. Accessed Sept. 10, 2012.
- Kasperkiewicz M, et al. Current therapy of the pemphigus group. Clinics in Dermatology. 2012;30:84.
- Venugopal SS, et al. Diagnosis and clinical features of pemphigus vulgaris. Dermatology Clinics. 2011;29:373.