Immunomodulatory therapy may be a very useful method of controlling severe or recalcitrant disease, but an RCT wherein patients receive either plasmapheresis (or IVIG) plus immunosuppressive agents, or immunosuppressive agents alone is needed. As it stands, plasmapheresis appears promising for its ability to eliminate what is assumed to be the source of disease - the autoantibodies. However, it is not clear whether plasmapheresis induces remission and prevents mortality more effectively than oral steroids alone. The literature on IVIG is even less conclusive. It may be an effective therapy in some patients, but further studies need to be conducted to establish its efficacy and to determine which patients may benefit from its use.

Does anti-inflammatory therapy (i.e. gold, dapsone, tetracycline) used as monotherapy or as a steroid-sparing agent effectively reduce symptoms and induce remission in patients with mild pemphigus vulgaris?

Anti-inflammatory agents are often prescribed for patients with relatively mild pemphigus, on the assumption that they are equally or more effective than other adjuvant agents, but pose less overall risk to the patient.

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