Mastering Pemphigus Vulgaris: From Classic Clinical Recognition to Evidence-based Therapeutic Management

Abstract

Background: Pemphigus vulgaris is an autoimmune blistering disorder characterised by fragile cutaneous blisters and painful mucosal erosions. Recognition can be difficult when specific diagnostic resources are limited. This case report describes the clinical findings, histopathological assessment, management and short-term evolution of an older patient. Case Presentation: A 77-year-old man presented with a three-month history of widespread cutaneous lesions affecting the trunk and extremities, together with erosions of the oral and genital mucosa. He reported an 8 kg weight loss over three months. Dermatological examination identified flaccid blisters, crusted erosions and mucosal involvement. Histopathological assessment of a skin biopsy showed acantholytic epidermal changes, moderate papillary dermal oedema and superficial perivascular lymphocytic infiltration, findings compatible with pemphigus vulgaris. Prednisone at 1 mg/kg/day was initiated alongside azathioprine and topical clobetasol 0.05%. After four weeks, approximately 80% of cutaneous lesions had re-epithelialised, accompanied by improvement in mucosal lesions. By eight weeks, the clinical lesions had resolved, leaving post-inflammatory hyperpigmented macules. Prednisone was gradually tapered, while azathioprine treatment continued. Conclusions: This case illustrates the contribution of recognising characteristic mucocutaneous findings and performing conventional histopathological assessment in a resource-limited clinical setting. The observed response to combined systemic and topical treatment documents favourable short-term evolution in this patient, without establishing long-term remission or comparative treatment effectiveness.