Patients undergoing treatment for pemphigus vulgaris require careful and ongoing monitoring to manage both disease activity and potential adverse effects of immunosuppressive therapies. Monitoring strategies should include regular clinical assessment for disease control and early detection of complications, alongside laboratory surveillance tailored to the immunosuppressive agents used.
Clinical monitoring involves frequent evaluation of skin and mucosal lesions to assess treatment response and detect new or worsening disease manifestations. This is essential as pemphigus vulgaris can have a fluctuating course and may require treatment adjustments Knudson et al. 2010.
Laboratory monitoring should include full blood counts, liver function tests, and renal function tests, especially when patients are treated with systemic corticosteroids and conventional DMARDs such as azathioprine or mycophenolate mofetil, which are commonly used in pemphigus vulgaris management. These tests help identify hematological toxicity, hepatotoxicity, and renal impairment early NICE CKS.
Because many patients receive systemic corticosteroids and immunosuppressants, monitoring for infections is critical. Patients should be advised to avoid exposure to infectious agents such as varicella-zoster virus and to seek urgent medical advice if exposed, as immunosuppression increases infection risk NICE CKS.
Specialist dermatology review is recommended regularly to guide treatment modifications and monitor for adverse effects, including secondary infections and drug toxicity Didona et al. 2019. Shared care protocols may allow primary care to undertake routine blood monitoring once the patient is stable, but initial and ongoing specialist oversight remains essential NICE CKS.
Vaccination status should be reviewed and updated before or during treatment to reduce infection risk, including annual influenza and pneumococcal vaccines NICE CKS.
In summary, monitoring strategies for pemphigus vulgaris include:
- Regular clinical assessment of disease activity and treatment response Knudson et al. 2010.
- Routine blood tests (FBC, LFTs, renal function) to detect drug toxicity, especially when using systemic immunosuppressants NICE CKS.
- Infection risk assessment and patient education on avoiding exposure and seeking prompt care NICE CKS.
- Specialist dermatology follow-up for treatment supervision and adverse effect management Didona et al. 2019.
- Vaccination updates to prevent serious infections NICE CKS.
Key References
- CKS - DMARDs
- NG130 - Ulcerative colitis: management
- CKS - Psoriasis
- CKS - Itch in pregnancy
- CG153 - Psoriasis: assessment and management
- CG163 - Idiopathic pulmonary fibrosis in adults: diagnosis and management
- (Knudson et al., 2010): The management of mucous membrane pemphigoid and pemphigus.
- (Didona et al., 2019): Pemphigus: Current and Future Therapeutic Strategies.
- (Sriram et al., 2025): Juvenile pemphigus vulgaris: A narrative review.