Opportunistic and Nosocomial Infections in Pemphigus Vulgaris and Foliaceus: Epidemiology, Pathogenesis, and Clinical Management Strategies

Background: Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune blistering disorders characterized by pathogenic autoantibodies against desmosomal adhesion proteins, leading to cutaneous and mucosal erosions. The extensive skin barrier disruption, combined with immunosuppressive therapies, predisposes patients to severe and recurrent infections, significantly impacting morbidity and mortality. Objective: This review examines the epidemiology, microbiological profiles, risk factors, and clinical management of infections in pemphigus patients, with a focus on bacterial, viral, fungal, and opportunistic pathogens. Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Web of Science, analyzing studies on infectious complications in pemphigus from 1990 to 2024. Results: The most prevalent infections include Staphylococcus aureus and Streptococcus pyogenesbacteremia, herpes simplex virus (HSV) reactivation, disseminated candidiasis, and opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP) in heavily immunosuppressed individuals. Corticosteroids and rituximab further exacerbate infection risks by inducing lymphopenia and hypogammaglobulinemia. Conclusion: Prophylactic antimicrobial strategies, early diagnosis, and judicious immunosuppression titration are critical in reducing infection-related complications in pemphigus. Multidisciplinary approaches involving dermatologists, infectious disease specialists, and microbiologists are essential for optimizing outcomes.