The nursing care of 1 case of elderly pemphigus with severe lower limb skin infection and type 2 diabetes was reported. Pemphigus patients complicated by diabetes often experience impaired lesion healing and are prone to severe infections, which pose significant challenges to treatment and nursing. In this case, phased targeted nursing care was provided based on the patient’s skin infection period, granulation growth period, and lesion healing period to create a favorable healing environment. Blood glucose levels were closely monitored and analyzed to prevent severe hyperglycemia and hypoglycemia. Dietary adjustments were made in a timely manner. After 27 days of active treatment and meticulous care, the patient’s condition improved with enhanced life confidence, well-controlled blood glucose and complete skin lesion healing, qualifying for discharge. Additionally, a literature review of recent reports on pemphigus with secondary infections is provided to offer insights and references for the management of such complex cases.