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Pathology · single question

What is the best treatment to manage pemphigus vulgaris?

  1. Doxycycline
  2. No treatment necessary
  3. Viscous lidocaine
  4. Corticosteroids
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Correct answer: D. Corticosteroids

CORTICOSTEROIDS (systemic prednisone) are the first-line treatment for pemphigus vulgaris. They suppress the autoimmune response (IgG auto-antibody production against desmogleins) and reduce the acantholysis and blistering. High-dose systemic prednisone induces remission, then the dose is tapered. Steroid-sparing agents (azathioprine, mycophenolate mofetil, rituximab) are added for maintenance. PV is potentially fatal if untreated.
  • A. INCORRECT. Doxycycline is an antibiotic/anti-inflammatory used in some bullous skin conditions (bullous pemphigoid as adjunct therapy) but is not the primary treatment for PV.
  • B. INCORRECT. PV is a potentially fatal condition if left untreated — it requires aggressive systemic treatment.
  • C. INCORRECT. Viscous lidocaine provides only local pain relief — it does not treat the underlying autoimmune pathology.
  • D. CORRECT. Systemic CORTICOSTEROIDS (prednisone) are the cornerstone treatment for PV. They suppress the autoimmune response causing the blistering. Biologic agents (rituximab) are now increasingly used, but corticosteroids remain the primary treatment.

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