Treatment Overview

Living with Pemphigus Foliaceus can be a physically uncomfortable and visibly distressing experience. Unlike other blistering conditions that affect deep layers of the skin, this autoimmune disorder primarily targets the top layer, leading to shallow blisters that break easily and form scaly, itchy crusts. These lesions often appear on the face, scalp, and chest, which can impact self-esteem and make social interactions feel daunting. While the condition is generally less severe than its counterpart, Pemphigus Vulgaris, the chronic itching and burning can significantly disrupt daily life and sleep.

Treatment is essential to stop the immune system from attacking the skin, allow existing lesions to heal, and prevent new blisters from forming. Without intervention, the widespread scaling can leave the skin vulnerable to secondary bacterial infections. Because the severity of Pemphigus Foliaceus ranges from mild, localized patches to widespread coverage, treatment plans are highly individualized. Doctors tailor medication choices based on how much of the body is affected and the patient’s overall health profile (National Organization for Rare Disorders, 2022).

Overview of treatment options for Pemphigus Foliaceus

The primary goal of treating Pemphigus Foliaceus is to induce remission, meaning the skin clears completely and no new lesions appear. Since this is an autoimmune disease, the strategy relies on suppressing the overactive immune response that is causing the skin cells to detach from one another.

For very mild, localized cases, treatment may be limited to external applications. However, most patients require systemic therapy to bring the condition under control. The treatment course typically involves an “induction phase” using stronger medication to rapidly stop the blistering, followed by a “maintenance phase” where doses are gradually lowered to the minimum amount needed to keep the skin clear. While sun protection is a critical lifestyle measure, as UV light can trigger flare-ups pharmacological intervention is the cornerstone of management.

Medications used for Pemphigus Foliaceus

Corticosteroids are the traditional first-line treatment for bringing the disease under control quickly. For mild cases, high-potency topical steroid creams may be sufficient. However, for more extensive disease, oral corticosteroids like prednisone are standard. These are effective at rapidly reducing inflammation and halting the formation of new blisters.

To avoid the long-term side effects of high-dose steroids, doctors frequently prescribe “steroid-sparing” agents. Dapsone, a sulfone medication, is particularly noted for being effective in Pemphigus Foliaceus. Other immunosuppressants include azathioprine, mycophenolate mofetil, and methotrexate. These drugs act slower than steroids but are crucial for long-term maintenance.

In recent years, biologics have become a significant part of treatment, especially for resistant cases. Rituximab, an intravenous medication originally used for lymphoma, is now widely used for pemphigus diseases. Clinical experience suggests that rituximab can lead to longer periods of remission and may allow some patients to eventually stop taking daily pills (American Osteopathic College of Dermatology, 2023).

How these medications work

In Pemphigus Foliaceus, the body produces autoantibodies that attack desmoglein-1, a protein that acts like “glue” holding the skin cells of the upper epidermis together. When this glue is destroyed, the cells separate, causing blisters and scaling.

Systemic corticosteroids work by broadly suppressing the immune system and reducing the inflammation that accompanies the antibody attack. This stops the immediate damage. Immunomodulators like azathioprine and mycophenolate work by inhibiting the reproduction of the white blood cells responsible for producing these harmful antibodies.

Biologics like rituximab offer a more targeted approach. They specifically deplete B-cells, which are the immune cells that mature into the factories producing the autoantibodies. By removing the source of the antibodies, the skin’s “glue” is preserved, allowing the epidermis to remain intact and healthy (International Pemphigus & Pemphigoid Foundation, 2021).

Side effects and safety considerations

Long-term corticosteroid use carries risks: weight gain, high blood pressure, elevated blood sugar, and osteoporosis. Therefore, doctors prioritize quickly transitioning to steroid-sparing agents.

Immunosuppressants and biologics raise infection risk by lowering defenses. Patients on these drugs need regular blood tests to monitor liver function and blood cell counts; Dapsone specifically requires anemia monitoring. Patients must avoid live vaccines and seek immediate medical care for infection signs (fever, chills) or sudden, widespread blistering (American Academy of Dermatology, 2022).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Academy of Dermatology. https://www.aad.org
  2. American Osteopathic College of Dermatology. https://www.aocd.org
  3. International Pemphigus & Pemphigoid Foundation. https://www.pemphigus.org
  4. National Organization for Rare Disorders. https://rarediseases.org

Medications for Pemphigus Foliaceus

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Pemphigus Foliaceus.

Found 6 Approved Drugs for Pemphigus Foliaceus

RiTUXimab

Brand Names
Rituxan, Ruxience, Riabni, Rituxan Hycela, Truxima

RiTUXimab

Brand Names
Rituxan, Ruxience, Riabni, Rituxan Hycela, Truxima
Form: Injection
Method of administration: Subcutaneous, Intravenous
FDA approval date: November 26, 1997
Classification: CD20-directed Cytolytic Antibody
RITUXAN is a CD20-directed cytolytic antibody indicated for the treatment of: Adult patients with Non-Hodgkin's Lymphoma (NHL).

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol
Form: Injection, Tablet
Method of administration: Oral, Intravenous, Intramuscular
FDA approval date: October 24, 1957
Classification: Corticosteroid
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of Methylprednisolone Sodium Succinate for Injection, USP, is indicated as follows: Allergic states Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases For the palliative management of leukemias and lymphomas. Nervous System Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog
Form: Kit
Method of administration: Intra-articular, Epidural, Topical, Intramuscular, Infiltration
FDA approval date: January 16, 2014
Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including triamcinolone acetonide injectable suspension is indicated for intramuscular use as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis and ulcerative colitis. Hematologic disorders: Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy. Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis and systemic lupus erythematosus. Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

Solu-Cortef

Generic Name
Solu-Cortef

Solu-Cortef

Generic Name
Solu-Cortef
Form: Injection
Method of administration: Intravenous, Intramuscular
FDA approval date: April 27, 1955
Classification: Corticosteroid
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of hydrocortisone sodium succinate for injection is indicated as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders: Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, select cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous System: Cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.

Multi-Specialty

Generic Name
Depo-Medrol

Multi-Specialty

Generic Name
Depo-Medrol
Form: Kit
Method of administration: Intra-articular, Infiltration, Topical, Intramuscular, Intralesional, Soft Tissue
FDA approval date: February 06, 2014
Lidocaine Hydrochloride Injection, USP is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed. A. For Intramuscular Administration When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intramuscular use of DEPO-MEDROL Sterile Aqueous Suspension is indicated as follows: Allergic States : Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, seasonal or perennial allergic rhinitis, serum sickness, transfusion reactions. Dermatologic Diseases : Bullous dermatitis herpetiformis, exfoliative dermatitis, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine Disorders : Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsupportive thyroiditis. Gastrointestinal Diseases : To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic Disorders : Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond Blackfan anemia), pure red cell aplasia, select cases of secondary thrombocytopenia. Miscellaneous : Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic Diseases : For palliative management of: leukemias and lymphomas. Nervous System : Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic Diseases : Sympathetic opthalmia, temporal arteritis, uveitis, ocular inflammatory conditions unresponsive to topical corticosteroids. Renal Diseases : To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus. Respiratory Diseases : Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic Disorders : As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. B. For Intra-articular Or Soft Tissue Administration (See WARNINGS ) DEPO-MEDROL is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. C. For Intralesional Administration DEPO-MEDROL is indicated for intralesional use in alopecia areata, discoid lupus erythematosus; keloids, localized hypertrophic, infiltrated inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis) and psoriatic plaques; necrobiosis lipoidica diabeticorum. DEPO-MEDROL also may be useful in cystic tumors of an aponeurosis or tendon (ganglia). For first aid to decrease germs in minor cuts scrapes burns For preparation of the skin prior to injection.
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