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Corticosteroids (oral or intravenous)
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Antibiotics and protective dressings for ruptured blisters
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Often immunosuppressants or immune globulin to reduce corticosteroid use
People who have moderate to severe disease are hospitalized. In the hospital, the raw skin surfaces require extraordinary care, similar to the care given to people with severe burns. Antibiotics may be needed to treat infections in ruptured blisters. Dressings can protect raw, oozing areas.
High doses of corticosteroids are an important part of treatment. They are taken by mouth (orally) or, if the person is hospitalized, may be given by vein (intravenously). If the disease is controlled, the dose of corticosteroids is gradually reduced (tapered).
If the disease is mild, treatment typically begins with rituximab, a drug that suppresses the immune system (immunosuppressant), or corticosteroids. Often, an immunosuppressant, such as azathioprine or mycophenolate mofetil, is also given.
If the disease is moderate or severe, treatment typically begins with rituximab or higher doses of corticosteroids. Often, azathioprine or mycophenolate mofetil, is also given.
Giving immunosuppressants reduces the need for corticosteroids in people who have needed corticosteroids for a long time or at high doses. Immune globulin given by vein is another treatment that can be used for severe pemphigus vulgaris. Some people respond well enough to discontinue drug therapy, whereas others must continue taking low doses of the drugs for long periods.
People with severe pemphigus vulgaris may also undergo plasma exchange, a process in which antibodies are filtered from the blood.
