Severe cases of pemphigus may need wound management, similar to the treatment for severe burns. People with this condition may need to stay in a hospital and receive care in a burn unit or intensive care unit.
Treatment is aimed at reducing symptoms, including pain. It also aims to prevent complications, especially infections.
Treatment may involve:
- Antibiotics and antifungal medications to control or prevent infections
- Fluids and electrolytes given through a vein (IV)
- IV feedings if there are severe mouth ulcers
- Numbing (anesthetic) mouth lozenges to reduce mouth ulcer pain
- Pain medications if local pain relief is not enough
Body-wide (systemic) therapy is needed to control pemphigus and should be started as early as possible. Systemic treatment includes:
- An anti-inflammatory drug called dapsone
- Medications containing gold
- Medications that suppress the immune system (such as azathioprine, methotrexate, cyclosporine, cyclophosphamide, mycophenolate mofetil, or rituximab)
However, side effects from systemic therapy are a major complication.
Some antibiotics are also effective, particularly minocycline and doxycycline. Intravenous immunoglobulin (IVIg) is occasionally used.
Plasmapheresis is a process in which antibody-containing plasma is removed from the blood and replaced with intravenous fluids or donated plasma. Plasmapheresis may be used along with systemic medications to reduce the amount of antibodies in the blood.
Ulcer and blister treatments include soothing or drying lotions, wet dressings, or similar measures.