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Treatments and drugs
By Mayo Clinic staffTreatment, which aims at reducing signs and symptoms and preventing complications, is most effective when it begins as early as possible. The less widespread pemphigus is, the easier it may be to control. Specific treatment methods depend on the severity of the disease.
Mild pemphigus
If your pemphigus isn't too widespread, you may be able to remain at home for treatment. 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 (Rheumatrex) 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.
- 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, such as dapsone, intravenous immunoglobulin and rituximab (Rituxan), may be prescribed.
Severe pemphigus
Widespread pemphigus may require you to stay in the hospital, where you may receive treatment similar to treatment for severe burns. The open sores make you highly vulnerable to infection, which, if it spreads to your bloodstream, may 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.
For some people, treatment makes all of the blisters and sores disappear completely in a few months, and treatment can be stopped. Others have to stay on a lower dose of the medications indefinitely or their signs and symptoms will return.
- Goldstein BG. Pemphigus. http://www.uptodate.com/home/index.html. Accessed April 6, 2010.
- Berger TG. Dermatologic disorders. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. 49th ed. New York, N.Y.: McGraw-Hill Medical; 2009. http://www.accessmedicine.com/content.aspx?aID=747. Accessed April 5, 2010.
- Stanley JR. Pemphigus. In: Wolff K, et al. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2970595. Accessed April 5, 2010.
- Pemphigus vulgaris. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec10/ch112/ch112f.html. Accessed April 5, 2009.
- Pemphigus. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Pemphigus/default.asp. Accessed April 5, 2010.
- Baroni A. Vesicular and bullous disorders: Pemphigus. Dermatologic Clinics. 2007;25:597.
- Gibson LE (expert opinion). Mayo Clinic, Rochester. April 9, 2010.
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