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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. 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:
- Weight gain
- Mood swings
- Elevated blood sugar (diabetes)
- Osteoporosis
- Redistribution of body fat, leading to a round face (moon face)
- Increased chance of infection because of suppression of the immune system
Corticosteroids may be combined with other medications, including:
- Immunosuppressants. These medications, such as azathioprine (Imuran) or methotrexate (Rheumatrex), help keep your immune system from attacking healthy tissue. These drugs have serious side effects, including increased risk of infection.
- Antibiotics and antifungal medications. These may be prescribed to control or prevent infections.
Additionally, other medications, such as dapsone, intravenous immunoglobulin and rituximab (Rituxan), also may be prescribed. These medications have had some success in treating pemphigus in small clinical trials.
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 also 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.
