Pemphigus Vulgaris


  • potentially fatal blistering disease

  • Autoimmune condition

  • bullae flaccid and surface removed easily

  • all races, esp. Ashkenazy jews, Indian subcontinent

  • can be drug induced (rare)

Pathology

  • split within epidermis

    • immunofluorescence shows IgG surrounding epidermal cells

  • development autoantibodies against desmosome proteins

  • superficial intraepidermal split

  • IgG within the epidermis

Clinical Features

  • Onset usually middle age

  • Mucosal involvement common

  • flaccid blisters

    • surface easily removed

  • particularly trunk

  • sore rather than itchy

  • Nikolsky sign

    • skin traction cause bulla to expand sideways

  • 50% patients have oral involvement

Treatment

  • very high dose prednisolone

  • azathioprine

  • cyclophosphamide

  •  cyclosporin

 

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