How would you treat pemphigus foliaceous in an elderly patient intolerant to oral steroids?

It depends on the extent of the disease and the severity of symptoms. Home wet wraps, when they can be done, can be essentially as effective as oral steroids in many situations, but can be time intensive. I provide the patient with instructions and a pound jar of triamcinolone ointment. Be careful since this can increase the risk of slip/fall. Depending on the situation, it is not totally unreasonable to consider inpatient wet wraps to achieve initial control, if home wet wraps cannot be perform...

Cellcept is a good alternative. It works but sometimes causes edema. The biologics, even off-label, are something to consider as well.