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List of All Topics
Pemphigus
Introduction
Pemphigus is a group of rare skin disorders that cause blisters of your skin or mucous membranes, such as in your mouth or on your genitals.
Pemphigus usually occurs in people between the ages of 30 and 60, but it also can affect children and older adults. Men and women develop pemphigus equally, and it affects all races and cultures. However, pemphigus tends to be more common in people of Middle Eastern or Jewish descent.
Usually a chronic condition, pemphigus is best controlled by early diagnosis and treatment, which may include medications or treatments similar to those used for severe burns. Left untreated, pemphigus may be fatal.
Signs and symptoms
Pemphigus is characterized by blisters on your skin and mucous membranes. The blisters rupture easily, leaving open sores, which may ooze and become infected. The signs and symptoms of the three main types of pemphigus differ depending on the type:
- Pemphigus vulgaris. The most common form, pemphigus vulgaris usually begins with blisters in your mouth, which then erupt on your skin. Blisters also can break out on the mucous membranes of your genitals. The blisters typically are painful, but don't itch.
- Pemphigus foliaceus. This type doesn't usually affect mucous membranes. The blisters, which usually begin on your face and scalp and later erupt on your chest and back, usually aren't painful. They tend to be crusty and itchy.
- Paraneoplastic pemphigus. This form causes painful sores on your mouth and lips and in your esophagus, as well as skin lesions. This form of pemphigus also can cause lesions in your lungs, resulting in progressive lung disease and making it difficult for you to breathe (dyspnea).
Causes
The exact cause of pemphigus is unknown, but it may be an autoimmune disorder.
Normally, your immune system attacks foreign invaders, such as harmful viruses and bacteria. But in pemphigus, your immune system produces antibodies that attack healthy cells in your skin or mucous membranes, specifically proteins called desmogleins. Desmogleins bind skin cells to each other. The antibodies cause separation of the cells of the top layer of your skin (epidermis). This reaction is known as acantholysis.
Paraneoplastic pemphigus generally occurs in people who have cancer, most commonly non-Hodgkin's lymphoma and chronic lymphocytic leukemia. In cases in which the cancer hasn't yet been discovered, the appearance of pemphigus blisters may alert doctors to look for a malignancy.
Treatment
Treatment, which aims at reducing signs and symptoms and preventing complications, is most effective when it begins as early as possible. The less widespread pemphigus is, the easier it may be to control. Specific treatment methods depend on the severity of the disease.
Mild pemphigus
If your pemphigus isn't too widespread, you may be able to remain at home for treatment. The mainstay of treatment is usually corticosteroids, such as prednisone. However, using corticosteroids over an extended time or in high doses may cause serious side effects, including:
- Weight gain.
- Mood swings.
- Elevated blood sugar (diabetes).
- Osteoporosis.
- Redistribution of body fat, leading to a round face (moon face).
- Hair loss.
- Increased chance of infection because of suppression of the immune system.
- Immunosuppressants. These medications, such as azathioprine (Imuran) or methotrexate (Rheumatrex), help keep your immune system from attacking healthy tissue. These drugs have serious side effects, including increased risk of infection.
- Antibiotics and antifungal medications. These may be prescribed to control or prevent infections.
Widespread pemphigus may require you to stay in the hospital, where you may receive treatment similar to treatment for severe burns. The open sores make you highly vulnerable to infection, which if it spreads to your bloodstream, may be fatal. Besides the medications listed above, you may be given:
- Fluids. Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — and proteins.
- Intravenous feeding. This may be necessary if mouth sores make it painful for you to eat.
- Anesthetic mouth lozenges. These can help control pain of mild to moderate mouth sores.
- Therapeutic plasmapheresis. In this process, the fluid part of your blood, called plasma, is removed from blood cells by a device known as a cell separator. The purpose is to get rid of the antibodies that are attacking your skin. The plasma is replaced with donated plasma or intravenous fluids.
Information obtained from National Institute of Health