UST - Touch Of Creativity Oral Medicine pemphigus vulgaris By: Dr.Shaima Alkasem

3. Definition :
An autoimmune vesiculobullous blistering
disease characterized by intra-epithelial blister
formation.

4. Aetiopathogenesis :
Circulating autoantibodies of (IgG) type target
the desmosomal complexes, Desmoglein 3
and 1 .

5. Epidemiology :
- Equal Incidence rate in both genders .
- Most patient presenting during the 4th and 5th
decades of life .
- Genetic and ethnic factors: Ashkenazic Jews
and Mediterranean patients .

6. Clinical features :
- Painful ulcers .
- Intra oral: Bullae apprear on any part of oral
mucosa and becomes ulcers, fig (1-2) .
- Extra oral : blisters appear on skin of face, back
or chest, fig(3) .
- Positive Nikolsky`s sign .

7. Clinical features :
Fig(1): ulcers in lower lip

8. Clinical features :
Fig(2): ulcers in buccal mucosa

9. Clinical features :
Fig(3): ulcers in skin of back

10. Diagnosis :
- Direct Immunofluorescence fig(4) .
- Indirect Immunofluorescence .

11. Diagnosis :
fig(4): Direct Immunofluorescence .

12. Differential Diagnosis :
- Mucous membrane pemphigoid .
- Erythema Multiforme .
- Paraneoplastic pemphigus .
- Pemphigus vegetans .

13. Treatment :
Based on disease severity :
* Mild :
- Topical corticosteroids .

14. Treatment :
* Moderate to sever :
systemic agents include :
- prednisone .
- mycophenolate mofetil .
- azathioprine .
- cyclosporine .