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Pemphigus, vulgaris on the back
Pemphigus, vulgaris on the back
Pemphigus, vulgaris - lesions in the mouth
Pemphigus, vulgaris - lesions in the mouth

Pemphigus vulgaris
Definition:
An autoimmune skin disorder characterized by blistering of the skin and mucous membrane.

Causes, incidence, and risk factors:

Pemphigus involves blistering of the outer (epidermal) layer of the skin and mucous membranes. It is an autoimmune disorder in which the immune system produces antibodies against specific proteins in the skin and mucous membrane. These antibodies produce a reaction that leads to a separation of epidermal cells (acantholysis). The exact cause of the development of antibodies against the body's own tissues (autoantibodies) is unknown.

Sometimes pemphigus appears due to reactions to medications, although this is rare. Pemphigus may be a side effect of ACE inhibitors (such as Elanapril) or chelating agents (such as penicillamine).

Pemphigus is uncommon. It occurs almost exclusively in middle-aged or older people, of all races and ethnic groups. About one-half of the cases of pemphigus vulgaris begin with blisters in the mouth, followed by skin blisters. The blisters (bullae) are relatively asymptomatic, but the lesions become widespread and complications develop rapidly and may be debilitating or fatal.

Symptoms:
  • skin lesions
    • recurrent or relapsing
    • blisters, flaccid
    • mouth ulcer or skin ulcers
    • may drain, ooze, crust
    • located on the mucous membrane of the mouth
    • located on the scalp, trunk or other skin areas
    • spreading to other skin areas.
    • superficial skin peeling or detaching easily
Signs and tests:
Treatment:
Severe cases of pemphigus are treated similarly to severe burns. Treatment may require hospitalization, including care in a burn unit or intensive care unit. Treatment is aimed at reducing symptoms and preventing complications.

Intravenous fluids, electrolytes, and proteins may be required. Mouth ulcers may necessitate intravenous feedings, if severe. Anesthetic mouth lozenges may reduce pain of mild to moderate mouth ulcers. Antibiotics and antifungal medications may be appropriate to control/prevent infections.

Systemic therapy as early as possible is required to control pemphigus, but side effects from systemic therapy are a major complication. Treatment includes corticosteroids, medications containing gold, or medications that suppress the immune system (such as azathioprine, methotrexate, or others).

Plasmapheresis (antibody-containing plasma is removed from the blood and replaced with intravenous fluids or donated plasma) may be used in addition to the systemic medications to reduce the amount of antibodies in the bloodstream.

Localized treatment of ulcers and blisters may include soothing or drying lotions, wet dressings, or similar measures.
Expectations (prognosis):
If not treated, pemphigus vulgaris is usually fatal. Generalized infection is the most frequent cause of death. Treated, the disorder tends to be chronic in most cases. Side effects of treatment may be severe or disabling.
Complications:
Calling your health care provider:

Any unexplained blisters should always be examined by your physician.

Call your health care provider if you have been treated for pemphigus vulgaris and you develop any of the following symptoms:
Review Date: 8/26/2002
Reviewed By: A.D.A.M. editorial. Previous review: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network (11/12/2001).
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