Systemic corticosteroids are the cornerstone of pemphigus therapy. Their use has transformed an almost invariably fatal illness into one whose mortality is less than 10%, probably closer to 5%.1
However, the serious side effects associated with the prolonged and high doses of corticosteroids required to treat pemphigus have prompted a search for adjuvant therapies that might reduce the need for this drug. Several adjuvant treatments have been suggested. These include a variety of cytotoxic drugs (azathioprine, cyclophosphamide, cyclosporine, methotrexate), gold, and dapsone. The value of these agents in the treatment of pemphigus is not clear for a variety of reasons,1 the most important being that no controlled study to formally establish effectiveness has been done with any adjuvant. In addition, most patients in adjuvant studies are concurrently treated with corticosteroids, so that it is difficult to know which agent is responsible for a clinical response. Equally troublesome is