Pemphigus vulgaris - Complications  

Secondary infections are a common complication of pemphigus vulgaris (PV).

The blisters caused by PV are vulnerable to bacterial infection and this is made worse as most of the medications used to treat PV weaken the immune system.

Symptoms of an infected blister include:

• the blister or surrounding skin becomes more painful and hot
• the blister is filled with yellow or green pus  
• there are red streaks leading away from the blister

It's important not to ignore an infected blister as it could potentially lead to secondary impetigo (a contagious bacterial infection of the skin) if it splits open (ruptures).

This could lead to further complications such as cellulitis (a bacterial infection of the deeper layers of the skin) or sepsis (a life-threatening infection of the blood).

Contact your GP or dermatologist if you think you may have an infected blister.

An infected blister can be treated with antibiotics.

Long-term corticosteroid use

If you are required to take steroid medication (corticosteroids) on a long-term basis (more than three months) the side effects include:

• further weight gain
• thinning skin that can bruise easily
• muscle weakness
• a combination of fatty deposits that develop in the face (moon face), stretch marks across the body and acne – this is known as Cushing’s syndrome
• weakening of the bones (osteoporosis)
• the onset of diabetes, or worsening of existing diabetes
• high blood pressure
• glaucoma – an eye condition where fluid gathers inside the eye
• cataracts – an eye condition where cloudy patches develop at the front of the eye
• delayed wound healing
• increased risk of infection

These side effects should improve if you're able to reduce your dosage. However, osteoporosis can be a persistent problem, particularly if you are over 65. This can make you more vulnerable to breaking a bone.

Your GP can prescribe medication, calcium and vitamin D supplements, which help strengthen your bones and can compensate for the effects of prednisolone. Find out more about treatment for osteoporosis.

You may also be referred for a type of X-ray called a dual energy X-ray absorptiometry (DEXA) scan. This can be used to assess how strong your bones are. See diagnosing osteoporosis for more information.

Stomach ulcers can also be a problem for people who take high doses of oral corticosteroids on a long-term basis. To protect against stomach ulcers, you may be prescribed a type of medication called a proton pump inhibitor (PPI). This reduces the amount of acid in your stomach, which will make you less vulnerable to developing stomach ulcers. Find out more about treating stomach ulcers.

You will also probably have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take oral corticosteroids on a long-term basis.

Immunosuppressants and cancer

There is evidence that taking an immunosuppressant on a long-term basis increases your risk of developing cancer, particularly skin cancer.

One study looked at people who were taking immunosuppressants to prevent their body from rejecting a kidney transplant.

The study found that just over half of these people developed cancer, typically 15 years after they began treatment.

It is unclear whether a similar risk exists in cases of PV and it may well be the case that you are not required to take an immunosuppressant for 15 years or more.

But as a precaution it is recommended that:

• you quit smoking if you smoke
• you avoid exposing your skin to too much sunlight
• you never use sunbeds or sun lamps

Read more about reducing your risk of cancer.