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Chapter-14 Pemphigus

BOOK TITLE: Essential of Dermatology, Venereology and Leprosy

Author
1. Chattopadhyay SP
ISBN
9788180610172
DOI
10.5005/jp/books/11611_14
Edition
1/e
Publishing Year
2003
Pages
3
Author Affiliations
1. Armed Forces Medical College Pune, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan; Calcutta Medical and Research Institute, Kolkata, West Bengal, India
Chapter keywords
Pemphigus vulgares, Blistering disease, Starts in oral mucosa, Skin lesions, Subsequently, Variants, Foliaceus, Erythematosus, Treatment, Oral corticosteroids, Cyclophosphamide, Methotrexate.

Abstract

Is a chronic blistering disease of middle-age characterized by acantholysis and bulla formation in epidermis basal layer? Types: Pemphigus vulgaris and vegetans, P. Foliaceus. Aetiology: Autoimmune, association of HLA 10 and DRW4 in Jews and Japanese, drug -like D-penicillamine, captopril and rifampicin produce pemphigus like picture. Clinical features: Mucous membrane lesions: fifty percent of patients with oral lesions, skin lesions follow 5 to 6 months after mucous lesions, characterized by small, flaccid, bullae mostly filled with clear fluid but rarely with pus. Site: Face, neck, trunk, pressure points axillae but may occur anywhere, Nikolsky’s sign is positive. Pemphigus vegetans is a variant of pemphigus vulgaris. Pemphigus Foliaceus and erythematosus: Probably a benign type of pemphigus with formation very superficial in epidermis. Investigations: Tzanck smear, skin biopsy, levels of circulating antibodies. Treatment: Corticosteroids, dose 1-2 mg/kg body weight. Initially a high dose to suppress bulla formation is given later to maintenance dose of 15 to 20 mg of prednisolone. Other immunosuppressant can be given. Specific: Immunosuppressants used as are follows-methotrexate 0.2 to 0.5 mg/kg body weight in 3 doses at 12 hourly, cyclophophamide-1 to 3 mg/kg/day, azathioprine-2.5 mg/kg/day.

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