Kakuta R, Kurihara Y, Yamagami J, et al. - Given that the Japanese guidelines for the management of pemphigus (JG) were published in 2010, however, further progress in the treatment of pemphigus needs their validation, researchers tested the safety and effectiveness of treatments based on the JG. The sample consisted of 84 Japanese individuals with moderate to severe pemphigus, who were initially treated in accordance with the JG and then followed up for > 2 years. Treatment usually consisted of 0.5–1 mg prednisone (PSL)/kg/day followed by 100 mg azathioprine/day as a steroid-sparing agent. Complete remission on minimal therapy (≤ 10 mg PSL/day and concomitant immunosuppressive agent) was achieved in 83 of the 84 patients. Adverse events have occurred in 67 patients, mainly elevation of the liver enzyme, infections, and diabetes. One patient died from gastrointestinal haemorrhage during the observation period. According to this retrospective study, elderly people and patients requiring additional treatments were at greater risk of adverse effects, including severe infections, and therefore should be carefully monitored. This research provided clinical data that might inform updated recommendations and lead to potential novel therapies evaluation.