Pemphigus is a group of autoimmune disorders that affects the skin. The attacks cause blisters and burn-like wounds on skin and mucous membranes (like mouth). There are three forms of the disease:
Pemphigus vulgaris—most common type of pemphigusPemphigus foliaceusParaneoplastic pemphigus—most serious type, usually occurs with
Pemphigus is an autoimmune disorder where the immune system attacks the skin and mucus membranes. The attack causes the sores on the skin.
It is not clear what causes the immune system to attack normal body tissue. For some, medication may be the cause.
Factors that increase your chance for pemphigus include: Family members with pemphigus
A history of having autoimmune diseases, such as
lupus, or thymoma
Jewish or Mediterranean descent
Regular use of certain drugs, including:
Pemphigus may occur over a small or large section of the skin. Itching and pain are common symptoms. Other symptoms will vary according to the type of pemphigus:
Lesion may extend deep into the skinBlisters usually start in the mouth or on the scalpLesions progress to the face, neck, upper body, armpits, and groinBlisters also may occur in the esophagus, rectum, nose, throat, larynx (voice box), eyes, vulva, or rectumSurrounding skin may be red or normal colorOpen sores are painfulPressure on the blister may cause it to expand into surrounding tissueOuter layer of skin can easily be rubbed offBlisters are soft and break easily, releasing fluidLarge areas of skin may open up, increasing the risk of fluid imbalance and infectionBlisters usually heal without scarring, but skin color may change to brown
Lesions are superficialBlisters are itchy or produce a burning sensationSores are usually not found in the mouth or on other mucus membranesBlisters usually first show up on the face, scalp, chest, or upper backBlisters open, causing shallow soresSkin is redScales and crusts formSunlight may make symptoms worse
Sores occur on the mucous membranes, in the mouth, eye, and esophagusBlisters often appear on palms of hands and soles of feetLesions are itchy or painful
The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include a thorough skin exam. Special care is given to examining the lesions.
Tests to look for signs of an autoimmune disorder may include:
of the lesion and surrounding tissue
Blood and skin tests
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There is no cure for pemphigus but treatment may help control your condition. If left untreated, pemphigus can lead to death.
Treatment aims to control the disease and prevent infection of the blistering lesions.
If a drug triggered pemphigus, the doctor will stop that medication. In some cases, stopping the drug is all that is needed for recovery.
Wound care is important to prevent infections. The wounds are treated similarly to severe
burns. They will be cleaned and protected from further contamination. Antibiotics medication will also be applied to the wounds to prevent infections.
Medications can usually help control symptoms. However, these medications can also produce serious side effects. Your doctor may order blood and urine tests to check for adverse effects.
Drugs that may be given include the following: Steroids—reduce swelling and calm the immune systemImmunosuppressive medications—decrease the strength of your immune systemAntibiotics—treat or prevent infectionMedicated mouthwash—for pain reliefIV immunoglobulin—immune system elements from a healthy immune system, often given in combination with rituximab (a biologic antineoplastic agent)Topical steroids, including injection into specific lesions
It takes some time for the immune system to clear. In fact, it may be several months or years for the skin sores to disappear. Some may have a complete remission after a period of medication treatment. Others will need to continue smaller doses of medication between outbreaks.
Sores in the mouth can make eating and dental care difficult. It is important to maintain good dental hygiene. If you cannot brush because of mouth sores, talk to your dentist. They can provide alternative ways to keep you mouth clean.
Lesions in the mouth can also make it difficult to eat. Soft diets may help until the lesions heal. Talk to a dietitian if you are having trouble getting adequate nutrition with a soft diet.
Avoid foods that can cause irritation in your mouth. This includes foods that are high in acids, spicy, or hard.
Good overall nutrition helps the body heal and fight disease.
Some foods may also make your symptoms worse. They may also trigger the onset of more sores. Foods that have been linked to these problems include garlic, onions, and leeks. Keep track of the foods that seem to cause a reaction in your skin. Read the labels of all foods to make sure they do not contain foods that can set off a reaction.
Paraneoplastic pemphigus may require the removal of a tumor. The removal may improve the disorder or decrease symptoms.
There are no guidelines for preventing pemphigus because the cause is unknown.