Treatment usually begins with medications that are intended to reduce signs and symptoms and prevent complications. It's generally more effective when it begins as early as possible. Treatment may also involve a hospital stay. Pemphigus may be life- threatening.
The following prescription medications may be used alone or in combination, depending on the type and severity of your pemphigus:
Corticosteroids. For people with mild disease, corticosteroid cream may be enough to control it. For others, the mainstay of treatment is corticosteroids, such as prednisone pills.
Using corticosteroids for a long time or in high doses may cause serious side effects, including increased blood sugar, bone loss, an increased risk of infection, cataracts, glaucoma and a redistribution of body fat, leading to a round face (moon face).
- Immunosuppressants. Medications such as azathioprine (Imuran) or mycophenolate mofetil (CellCept) help keep your immune system from attacking healthy tissue. They may have serious side effects, including increased risk of infection.
- Biological therapies. Your doctor may suggest a drug called rituximab (Rituxan) if other medications aren't helping or are difficult for you to tolerate. This drug is given as an injection. It targets the white blood cells responsible for the production of the pemphigus antibodies.
- Antibiotics, antivirals and antifungal medications. These may be used to control or prevent infections.
- Other medications. Other drugs that alter the immune system may be effective. These include dapsone and intravenous immunoglobulin.
Some therapies for pemphigus may require a hospital stay. Along with medications listed above, you may be given:
- Fluids. Because skin sores can result in significant loss of fluid from your body, replacing fluids may be an important part of treatment. You may receive fluids through a vein (intravenously).
- Intravenous feeding. This may be necessary if mouth sores make it too painful for you to eat. You may receive fluids and nutrients through a tube placed through your nose and advanced into your stomach (nasogastric tube) until normal nutrition can be restored.
- Anesthetic products for the mouth. 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.
- Wound care. You may be given gentle baths and dressings to help your blisters and sores heal.
Many people get better with treatment, although it may take years. Others need to take a lower dose of medication indefinitely to prevent their signs and symptoms from returning.