Pemphigus Vulgaris

WHAT IS IT?

Pemphigus vulgaris is a dermatological condition  characterized by the presence of flaccid bullae and ulcers. 

WHAT CAUSES IT?

 

WHY IS IT CONCERNING MEDICALLY?

 

WHAT IS THE INTIAL PRESENTATION?

Patient Chief Complaints:

  • Skin sores
  • Rash/bumps on skin

Detected Medical Problems:

  • Bullae can be detected on the dermatological exam. 
WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

 

Medical History:

 

WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Vital Signs:

 

Dermatological Exam:

  • Flaccid bullae can be present in patients 
  • Ulcers may be on the skin in places where bullae once existed but have eroded away
  • Mucosal erosions are also present sometimes
  • Nikolsky sign may be positive 
CLINICAL WORKUP: SERUM STUDIES

 

CLINICAL WORKUP: IMAGING

 

CLINICAL WORKUP: SKIN BIOPSY

Light Microscopy/Histology:

  • Intraepidermal cleavage 
  • Acantholysis (detached keratinocytes) 
  • Tombstone cells may be present along basement layer 

Immunofluorescence:

  • Netlike intracellular presence of IgG. 
HOW DO WE NARROW THE DIFFERENTIAL?

Conditions that present similarly and how to exclude them:

 

WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

 

PATIENT MANAGMENT: SYMPTOM RELEIF

 

PATIENT MANAGEMENT: DISEASE TREATMENT

Aggressive Wound Care:

Systemic Glucocorticoids: 

PATIENT MANAGEMENT: PROPHYLACTIC MEASURES

 

COULD THIS HAVE BEEN PREVENTED?

 

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

 

Page Updated: 02.15.2017