Management of Refractory Pemphigus Vulgaris through Ayurvedic Shodhana Therapy: A Case Report

Pemphigus Vulgaris (PV) is a chronic autoimmune blistering disorder characterised by painful mucocutaneous erosions. Standard management relies on systemic corticosteroids and immunosuppressants; however, many patients experience relapses when doses are tapered, leading to refractory disease. Present case report is of a 36‑year‑old female with extensive erosions (60% body surface area) and recurrent “rebound flares” despite prolonged steroid therapy. Seeking a steroid‑sparing alternative, she underwent a structured Ayurvedic Shodhana (bio‑purification) protocol comprising Vamana (therapeutic emesis), Virechana (therapeutic purgation), and adjunctive Jalaukavacharana (leech therapy), along with supportive internal and external care. Over 12 weeks, progressive improvement was observed, with near-complete clinical remission with full re-epithelialisation of cutaneous and mucosal lesions. While this case highlights the potential role of Ayurvedic detoxification therapies in refractory PV, the absence of standardised scoring indices and immunopathological confirmation limits generalisability. Larger, controlled studies are warranted to objectively evaluate efficacy and long‑term outcomes.