A Comprehensive Integrative Review of Pemphigus Vulgaris: Modern Pathophysiology and Ayurvedic Management (Visphota)

Pemphigus vulgaris (PV) is a rare, life-threatening autoimmune bullous dermatosis characterized by severe, non-healing erosions and flaccid blisters on the skin and mucous membranes. Modern pathophysiology attributes the disease to immunoglobulin G (IgG) autoantibodies targeting desmogleins (Dsg1 and Dsg3), leading to the loss of intercellular adhesion (acantholysis). While allopathic protocols rely heavily on systemic corticosteroids and immunosuppressants to induce remission, chronic use often leads to severe metabolic, bone, and immunological side effects. Ayurveda conceptualizes PV through the lens of Tridoshaja vitiation with a pronounced Pitta-Kapha dominance, clinically correlating it with Agnivisarpa (spreading erysipelas-like lesions) or Visphota (bullous eruptions), categorized under Rakta Pradoshaja Vikaras (blood-borne pathologies). This article comprehensively reviews the modern immunological landscape and the Ayurvedic pathological framework (Samprapti) of Pemphigus. It emphasizes an integrative management protocol—including Shodhana (purification), Shamana (pacification), Bahya Chikitsa (topical therapies), and Rasayana (immunomodulation)—to improve the quality of life, promote rapid mucosal re-epithelialization, and facilitate corticosteroid-sparing effects.