Plasma exchange in the management of pemphigus

Pemphigus is a severe cutaneous blistering disease caused by antiepidermal antibodies. The well-demonstrated role of autoantibodies and the side effects of conventional therapy with high doses of steroids prompted trials of plasma exchange (PE). While most open studies reported effectiveness of PE, mainly in steroid-resistant cases, a recent controlled study showed no benefit from PE when given with a low steroid dose. This study points to the difficulty of removing pemphigus antibody unless PE is accompanied by effective immunosuppression. Since steroids remain the principal immunosuppressive form of therapy in pemphigus, the clinical usefulness of PE in this disease may be restricted to the management of cases resistant to high steroid doses.