Treating pemphigus vulgaris

There's currently no cure forpemphigus vulgaris (PV), but treatment can help keep the symptoms under control.

Most people will need to take steroid medication (corticosteroids) in addition to another immunosuppressant medication. These help stop the immune system damaging healthy tissue.

The main aims of treatment are to:

  • heal the blisters and prevent new ones forming
  • reduce the dose of your medication gradually to the lowest possible dose that still controls yoursymptoms

It can take a while tofind outthe best dose for you. It may take a few months to reach a balance between controlling your symptomsand limiting unpleasant side effects.

You may eventually be able to come off your medication if your symptoms disappear and don't come back when treatment is stopped. However, many people will need to keeptaking a low dose.

Steroid medication

Steroid medicationcanhelpreduce the harmful activity of the immune system in a short space of time. It's usually taken as a tablet, although creams and injections are also sometimes used.

You usually start on a high dose to get your symptoms under control. This can lead to a noticeable improvement within a few days, although it usually takestwo to three weeks to stop new blisters formingand up to eight weeks for existingones to heal.

Once your symptoms are under control, your steroid dose will be gradually reduced to the lowest possible dose that can still control your symptoms. This will help reduce the risk of side effects.

Side effects

If taken for a long time at high doses, steroid medication can have a range ofunpleasant side effects, such as:

  • increased appetite and weight gain
  • thin skin that can bruise easily
  • acne
  • increased risk of infections
  • mood changesand mood swings
  • diabetes
  • high blood pressure
  • weakening of the bones (osteoporosis)

Most of these side effects should improve if you're able to reduce your dose. However,osteoporosis can be alasting problem.

These are usually taken as tablets.

Side effects

Like steroids, these medicines can make you more vulnerable to infection, so you will need to take precautions when taking them, such as:

  • avoiding close contact with someone known to have an active infection,such as chickenpox or flu
  • avoiding crowded places when possible
  • telling your GP or dermatologist immediatelyif you develop symptoms of an infection, such as ahigh temperature (fever)

Other possible side effects include:

  • your skin becomingvulnerable to the effects of sunlight
  • birth defects if the medication is taken during pregnancy

Additional treatments

Several other treatments are sometimes used in combination with steroid medication and other immunosuppressants if these medications alone don't fully control your symptoms.

These include:

  • tetracycline and dapsone antibiotic tablets that can alter the activity of the immune system
  • rituximab a new type of medication that helps stop your immune system attacking your skin cells;it's usually given by dripdirectly intoa vein over a few hours
  • plasmapheresis where your blood is circulated through a machine that removes the antibodies that attack your skin cells
  • intravenous immunoglobulin therapy wherenormal antibodies from donated blood that temporarily change how your immune system works are given through a drip

These treatments don't tend to be used very often and aren't always widely available. For example,rituximab isrelatively expensive and some clinical commissioning groups (CCGs) may not fund it.

Content supplied by the NHS Website

Medically Reviewed by a doctor on 28 Nov 2016