Treatment of pemphigus: Drugs and topical therapies

The aim of pemphigus treatment is mainly to stop the formation of blisters, to alleviate or even disappear the symptoms of the disease.

What is the course of treatment?

Pemphigus belongs to the group of chronic blistering skin diseases. It is therefore a long-term disease. The patient must realize that the treatment is lengthy and requires a huge amount of patience.

In general, the slow healing of the manifestations usually takes 1 to 3 months.

Corticosteroids are used in the treatment of pemphigus. Their therapeutic dose is chosen according to the extent of the disease.

The doctor can reduce the dose of systemic corticosteroids only after the disease has reached a degree of control. Or if new blisters no longer form and the old blisters have healed.

After 14 days, the doctor may reduce the dose of corticosteroids by 25%. However, if fewer than 3 blisters appear, they must return to the last dose.

If there is a recurrence (reappearance, worsening of symptoms), the corticosteroid dose must be increased again. After 2 weeks, the dose can be reduced again.

The following table lists the different drugs from the corticosteroid group that are used in the treatment of pemphigus

Medication	Application form	Effects
Methylprednisolone	Tablet	Suppresses symptoms of local inflammation - fever, swelling, pain, redness
Prednisone	Tablet	Suppresses inflammation, allergic symptoms
Betamethasone	Suspension for injection	Relieves inflammation, swelling, itching

If corticosteroid treatment does not work, the doctor may add immunosuppressants to the treatment:

Immunosuppressants I. Choice

Azathioprine
Mycophenolate mofetil

Immunosuppressive treatment has many side effects in addition to its curative effects. The incidence of side effects depends on the duration of administration. Higher doses are also of great importance.

Side effects can be divided into the following groups:

mineralocorticoids - increase in blood pressure, fluid and sodium retention
glucocorticoids - obesity, osteoporosis, impaired glucose tolerance
psychiatric - depression, paranoid states

Local treatment

Local treatment of pemphigus is given great importance.

Repeated admixture baths are applied:

disinfectant
astringent substances (tannin)
reducing agent (ichthamol)

Emollients, epithelizing creams and topical corticosteroids can be used for local treatment.

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PharmDr. Štefánia Laca Megyesi, PhD., MSc.

Doctor of Pharmacy

I graduated from the University of Veterinary Medicine and Pharmacy in Košice. After graduation I stayed working at the University. Until 2019, I was leading practical exercises in the subject of Drug Technology. I was mainly engaged in the preparation of individually prepared medicines in pharmacies. During my time there, I wanted to keep learning. In 2016, I defended my rigorous thesis at the Veterinary and Pharmaceutical University in Brno. By completing the rigorous procedure I gained knowledge in the field of laws related to pharmacy and medicine. In 2017, I completed my MHA studies at St. Elizabeth's College of Health and Social Work. By studying, I gained knowledge in the field of public health. In 2021 I completed my PhD studies (specialization in parasitic diseases) at the University of Veterinary Medicine and Pharmacy in Košice. The desire to learn new things and new knowledge led me to become a co-founder of the dermatovenerology outpatient clinic. And why can I give you information from the medical and pharmaceutical field? I like to learn and get to know new things. I have focused all my studies and scientific research on skin diseases. I have also gained knowledge in the field of parasitic diseases. Writing is one of my hobbies and a kind of relaxation.

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