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• Lesion may extend deep into the skin
• Blisters usually start in the mouth or on the scalp
• Lesions progress to the face, neck, upper body, armpits, and groin
• Blisters also may occur in the esophagus, rectum, nose, throat, larynx (voice box), eyes, vulva, or rectum
• Surrounding skin may be red or normal color
• Pressure on the blister may cause it to expand into surrounding tissue
• Outer layer of skin can easily be rubbed off
• Blisters are soft and break easily, releasing fluid
• Open sores are painful
• Large areas of skin may open up, increasing the risk of fluid imbalance and infection
• Blisters usually heal without scarring, but skin color may change to brown

• Lesions are superficial
• Blisters are itchy or produce a burning sensation
• Sores are usually not found in the mouth or on other mucus membranes
• Blisters usually first show up on the face, scalp, chest, or upper back
• Blisters open, causing shallow sores
• Skin is red
• Scales and crusts form
• Sunlight may make symptoms worse

• Sores occur on the mucous membranes, in the mouth, eye, and esophagus
• Blisters often appear on palms of hands and soles of feet
• Lesions are itchy or painful

Wound care is important to prevent infections. The wounds are treated similarly to severe burns . They will be cleaned and protected from further contamination. Antibiotics medication will also be applied to the wounds to prevent infections.

Medications can usually help control symptoms. However, these medications can also produce serious side effects. Your doctor may order blood and urine tests to check for adverse effects.

Drugs that may be given include the following:

• Steroids—reduce swelling and calm the immune system
• Immunosuppressive medications—decrease the strength of your immune system
• Antibiotics
• Medicated mouthwash—for pain relief
• IV immunoglobulin—immune system elements from a healthy immune system, often given in combination with rituximab
• Topical steroids, including injection into specific lesions

It takes some time for the immune system to clear. In fact, it may be several months or years for the skin sores to disappear. Some may have a complete remission after a period of medication treatment. Others will need to continue smaller doses of medication between outbreaks.

Sores in the mouth can make eating and dental care difficult. It is important to maintain good dental hygiene. If you can not brush because of mouth sores, talk to your dentist. They can provide alternative ways to keep you mouth clean.

Lesions in the mouth can also make it difficult to eat. Soft diets may help until the lesions heal. Talk to a dietitian if you are having trouble getting adequate nutrition with a soft diet.

Avoid foods that can cause irritation in your mouth. This includes foods that are high in acids, spicy, or hard.

Good overall nutrition helps the body heal and fight disease.

Some foods may also make your symptoms worse. They may also trigger the onset of more sores. Foods that have been linked to these problems include garlic, onions, and leeks. Keep track of the foods that seem to cause a reaction in your skin. Read the labels of all foods to make sure they do not contain foods that can set off a reaction.

Paraneoplastic pemphigus may require the removal of a tumor. The removal may improve the disorder or decrease symptoms.