Initially, administration of prednisone in a single daily dose of 200 mg or more may be needed to suppress blister formation. Suppression can usually be accomplished within six to 10 weeks, after which the dosage can gradually be reduced to 40 mg, administered on alternate days. Intralesional injection of glucocorticoids is useful for the management of localized disease, such as oral ulcerations. It is important to prevent infection of any denuded skin areas. Bacteria from secondary infections must be cultured, and systemic antibiotics should be given.
Immunosuppressive drugs are one form of adjuvant therapy.
Azathioprine should be administered in combination with steroids initially because its effects are not evident for the first one to two months of therapy. The combination of azathioprine and glucocorticoid may be an effective therapy when steroids alone have failed to control the disease, and such combined therapy can lead to long-term remission. A 10 mg dose of either compound is administered intramuscularly to test for idiosyncratic reactions. If none are observed, a 25 mg parenteral dose of the gold compound is given the first week, and the dose is increased to 50 mg once a week until a positive response is seen. Maintenance therapy consists of injections of 50 mg or less administered from every other week to once a month as needed.