What are the treatment options for pemphigus?
Without treatment, pemphigus tends to worsen. Some types of pemphigus can become life-threatening without treatment. Treatment usually begins with medications to stop more blisters from forming. The earlier treatment starts, the more effective it will be. If a medication triggers your pemphigus, stopping that drug may be sufficient to stop your pemphigus. Many people improve slowly with medications. Others may need to take medication for the rest of their life to keep symptoms from returning.
Medications depend on the type and severity of your disease, and if you have other health conditions. Before medicines like prednisone were used to treat pemphigus vulgaris, patients only lived about five years. Today, very few people die of pemphigus.
Treatment may include these medications, prescribed alone or in combination:
- Corticosteroid cream may bring relief in mild cases. More serious cases require an oral corticosteroid such as prednisone pills. Taking corticosteroids for a long time (or in high doses) can cause serious side effects. They can include diabetes, bone loss, higher chance of infections, stomach ulcers and redistribution of body fat to the face (moon face).
- Immunosuppressant drugs can keep your immune system from attacking the body’s healthy tissues, and can stop the body from creating new blisters. However, these drugs can increase your risk of infections.
- Other medications may be required if the above are not helping. Your dermatologist may prescribe dapsone, intravenous immunoglobulin or rituximab.
- If you have an infection, you may need antibiotics, antivirals, or antifungals.
- Biologics are showing promise against pemphigus.
Very serious cases, or if treatment isn’t working, may benefit from one of these treatments:
- Plasmapheresis removes plasma from your blood, and it’s replaced with healthy plasma from a blood donor. The proteins that cause your immune system to attack skin and mucous membranes are contained in blood plasma.
- Extracorporeal photochemotherapy removes white blood cells from your blood. They are treated with a medication, and exposed to ultraviolet-A light to kill the diseased white cells. The treated blood is returned to your body.
- Hospitalization may be needed to get an intravenous (IV) to replace the large amount of fluid lost from widespread sores, and to get much-needed nutrition. Medications can be started in the hospital to get pemphigus under control.
Lifestyle changes and home remedies should be included in treatment plans.
- Follow your doctor’s wound-care instructions to prevent infections and scars. Use mild soap to clean your skin and apply moisturizer immediately afterward.
- Avoid activities where you could hurt your skin, because even a minor injury can cause new blisters.
- Avoid spicy, hot or rough foods if you have active blisters in your mouth.
- Stay out of the sun as much as you can because ultraviolet light can trigger new blisters. High temperatures can also worsen your symptoms and cause blisters to spread.
- If it’s difficult to brush your teeth because of mouth blisters, ask your dentist how to clean your mouth, teeth and gums without injuring them. Ask about an anesthetic to reduce the pain of eating and brushing your teeth.
- Pemphigus can be very difficult to live with and you may benefit from a support group, and regular stress reduction techniques or activities.
- If your eyes are involved, avoid contact lenses and wear sunglasses to ease light sensitivity.
