Experts have suggested that there may be external, perhaps environmental factors (sometimes known as exogenous factors) which act as triggers (start the disease off) or aggravating factors (make it worse) (see ‘Does anything make pemphigus vulgaris worse?’) ^10,11.

These may be:

• Some types of drugs. Drugs based on D-penicillamine, Captopril (now rarely used) and Rifampicin ¹². In some cases, PV may resolve after stopping these drugs. It is thought that in individual cases, other types of drugs may trigger pemphigus.
• Nutritional factors particularly foods from the allium family (such as garlic, onions and leeks).¹¹
• Physical agents such as burns, ultra-violet radiation (from sunshine and sunbeds) and X-rays.
• Infections, particularly viral infections.
• Stress, which may be:
  • emotional stress.
  • physical stress due to exhaustion (even from pleasant activities).
• Physical trauma to the body, for example, an operation or bad injury.
• Hormones and/or pregnancy.
• Contact dermatitis (an allergic skin reaction).

People with PV often over time learn to recognise what triggers may make their condition worse, so that they can take steps to avoid them or reduce their impact. It is important to remember that one person's trigger may be totally harmless to someone else.

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