Overall I find initial therapy is nearly always high to moderate dose of corticosteroids with the introduction of a steroid sparing agent once control is achieved. Our rhuematologists use pulse as an outpatient treatment in patients without cardiac rhythm problems and without risks for potassium fluxes. A baseline EKG and then a glucose and potassium determination before each infusion are prudent. An EKG rhythm strip could also be done before each infusion but is probably not necessary for otherwise healthy patients. For pemphigus, you may need to pulse as often as every two weeks but decrease to monthly as other treatments kick in.
Monitoring includes watching for proteinuria.
Watch out for ACE inhibitors, they can cause a pemphigus-like eruptions. Finally, don't forget that hydroxychloroquine can be effective for pemphigus foliaceus. Cyclosporine for the treatment of pemphigus vulgaris. Treatment of pemphigus vulgaris with pulse intravenous cyclophosphamide. Decompensation in proteinase-inhibitor system and application of proteinase inhibitors in pemphigus and pemphigoid.