Pemphigus

Monitoring mainly involves managing the adverse effects of immunosuppression. Long-term corticosteroid use is associated with significant morbidity including mental disturbances, increased susceptibility to infections, avascular necrosis of the hip, diabetes, hypertension, skin atrophy, and poor wound healing. Serious adverse effects include adrenal insufficiency, Cushing's syndrome, and gastrointestinal ulceration/perforation. Patients should be monitored for diabetes, high blood pressure, premature osteoporosis, and symptoms of GORD or gastric or duodenal ulcers.

Patients taking prolonged courses of systemic corticosteroids are at increased risk for osteoporosis and accompanying fractures; therefore, it is imperative to monitor bone density by routine dual-energy x-ray absorptiometry scan and give calcium, vitamin D, and bisphosphonates for bone supplementation.

In patients with paraneoplastic pemphigus, close monitoring of lung function with pulmonary function testing and lung diffusion capacity testing is critical to assess for evidence of bronchiolitis obliterans.