The role of nutrition in patients with pemphigus receiving prolonged corticosteroid therapy

Pemphigus is a rare autoimmune blistering disorder that affects the skin and mucous membranes, characterised by acantholysis due to IgG-mediated autoantibody interference with desmoglein-mediated keratinocyte adhesion. Despite advances in immunosuppressive therapy, managing pemphigus remains a challenge. Both disease pathology and treatments, especially corticosteroids, contribute to nutritional deterioration. Extensive skin lesions cause high protein loss, and mucosal involvement leads to dysphagia, which leads to reduced dietary intake. At the same time, long-term steroid use will intensify the malnutrition condition due to the adverse effects of the medication, such as insulin resistance, obesity, dyslipidaemia, and calcium/vitamin D depletion. This review highlights the critical yet often overlooked role of nutritional management in pemphigus clinical care. Routine nutritional screening using Nutritional Risk Screening (NRS-2002), recognised as a more reliable tool than body mass index (BMI), should be implemented along with a thorough evaluation of both macronutrient and micronutrient intake to enhance wound healing and mitigate steroid-related adverse effects. Specific recommendations include complex carbohydrates, omega-3 fatty acids, and oral nutrition supplementation. Moreover, avoiding dietary triggers such as thiol-, phenol-, and tannin-rich foods is advised to reduce flare risk in genetically susceptible individuals.