A tailored dosing schedule of steroids has been advocated according to the severity of the disease. Mild disease can be treated with an initial prednisone dose of 40 to 60 mg/d; in severe cases, 60 to 100 mg/d. Other agents that have been used to treat pemphigus vulgaris are intramuscular gold, dapsone, and intravenous immunoglobulin.
Patient outcome
The patient was treated with oral prednisone starting at 60 mg/d and her skin began to clear. A full course of oral prednisone was continued and tapered over 1 month. Currently, she remains in remission off all medications.
Conclusion
Pemphigus vulgaris is a potentially life-threatening condition that must be recognized and treated promptly. With a lack of large-scale controlled studies, the diagnosis and management of pemphigus vulgaris has based on expert opinion.3 Complications such as superimposed infection of the lesions, cellulitis, and sepsis can occur. Its association with underlying neoplasm, thymomas, myasthenia gravis, and other autoimmune disorders warrants consideration for additional workup when indicated.
Correspondence
John Sauret, MD, Department of Family Medicine, State University of New York at Buffalo, 150 Family Medical Modular Complex, Buffalo, NY 14214-3013. E-mail: sauret@buffalo.edu.