Pemphigus Vulgaris Unveiled: From Nikolsky's Sign to Immunofluorescence

Abstract Oral pemphigus vulgaris (PV) is a rare, chronic, autoimmune, mucocutaneous disorder characterized by the formation of flaccid blisters and painful erosions, predominantly affecting the oral mucosa. This case report describes a 52-year-old female presenting with ulcerations in the buccal mucosa as well as alveolar mucosa, accompanied by a positive Nikolsky’s sign. Diagnostic investigations including cytology, histopathology, and direct immunofluorescence, confirmed the diagnosis of PV, revealing characteristic features such as suprabasilar split, Tzanck cells, and a “fish-net” pattern of IgG deposition. Early diagnosis and initiation of systemic corticosteroids and immunosuppressive therapy are crucial in reducing morbidity and preventing complications. This report, emphasizes the importance of early recognition, particularly by dental professionals, and highlight the advances in treatment strategies including the role of therapeutic agents like rituximab, in improving patient outcomes.