To get the PV under control, treatment usually starts with Corticosteroids. This is because they are effective and work quicker than most Other Treatments. Corticosteroids are man-made versions of hormones produced naturally by the body. They work by suppressing the immune system (see ‘What causes pemphigus vulgaris?’). It is important to remember that Corticosteroids are different from the steroids used by body builders, which are called anabolic steroids.

Prednisolone is usually the first corticosteroid to be used.

Corticosteroid treatment can be started in one of two different ways:

• Oral Corticosteroids (by mouth). If there are widespread blisters and erosions the dose of prednisolone is usually high to start with (between 60 and 100mg per day). If the PV is less severe then the dose will probably be lower (around 30-60mg per day) ^7,16.
• Intravenous Corticosteroids (through a drip, directly into a vein). These are usually given to patients with more severe PV. A typical treatment regime would be 0.5-1g methylprednisolone for three days in a row. This is then usually followed by oral prednisolone.

Once your PV is controlled, the dose of prednisolone is slowly lowered to reduce side-effects. However, it is not usually stopped completely because most people need a (relatively) small dose to keep the disease under control. This is called a maintenance dose. This is usually about 10mg a day but the exact dose depends on the weight of each individual.

Remember, it is dangerous to stop Corticosteroids suddenly, so always be guided by your doctor.

Patients on Corticosteroids are carefully monitored for side-effects (see ‘Side-effects of Corticosteroids’).

These checks will include:

• measuring your blood pressure and weight
• taking urine samples to check for sugar
• taking blood samples to check for blood sugar levels
• bone density scans (important to check for thinning of the bones, called osteoporosis or brittle bone disease)

If you are on long-term Corticosteroids you should be given a steroid treatment card which you should carry with you. This card contains details of the drugs you are taking and how to minimise risk.

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