Pemphigus Vulgaris: Case Report and Review of Current Treatment Algorithms

Background: Pemphigusvulgaris (PV)is a rare autoimmune blistering disorder affecting the skin and mucous membranes. It is mediated by pathogenic IgG autoantibodies against desmoglein 3 and desmoglein 1—key components of desmosomes responsible for keratinocyte adhesion. Case Summary: We report a case of a 45-year-old female with a history of hypothyroidism who presented with painful, flaccid blisters and oral erosions. Clinical examination, supported by histopathology and direct immunofluorescence, confirmed the diagnosis of PV. The patient was treated with high-dose intravenous prednisolone and azathioprine, which led to clinical stabilization, cessation of new lesions, and progressive healing. This case highlights the importance of early recognition and timely initiation of systemic therapy to prevent complications such as infection, dehydration, and nutritional deficiency. While corticosteroids remain the mainstay of treatment, adjunctive immunosuppressants help reduce steroid burden. In severe or refractory cases, biologics such as rituximab are now established as effective firstline agents. Long-term remission requires a multidisciplinary and individualized approach