Pathology · patient case question
What is the first-line treatment for this condition?
Patient case: Gums That Peel
Patient: 61-year-old female
Chief Complaint: “My gums peel away and I keep getting blisters that pop and leave raw spots.”
Background: Symptoms present for 5 months and worsening. Difficulty eating due to pain. She also reports persistent dry mouth. No known autoimmune disease.
Medications: Sertraline · Oxybutynin · Loratadine
Vital Signs: BP 130/80 mmHg · HR 76 bpm · RR 16 · T 98.6°F
Findings: Diffuse erythematous, desquamating attached gingiva in all quadrants. Flaccid bullae on the buccal mucosa that rupture readily, leaving ragged, painful ulcers. Firm lateral pressure on clinically uninvolved mucosa induces epithelial sloughing. Reduced salivary pooling; multiple new cervical carious lesions since her last visit.
Show answer and explanation
Correct answer: D. Systemic corticosteroids
- A. Incorrect. Tetracycline rinses have adjunctive anti-inflammatory value in some mucosal conditions but are wholly inadequate as monotherapy for a potentially life-threatening autoimmune disease.
- B. Incorrect. Antivirals treat herpetic infections. There is no viral component to pemphigus vulgaris.
- C. Incorrect. Candidiasis is frequently a secondary complication of corticosteroid therapy and does require treatment when it appears, but it is not the underlying disease.
- D. Correct. Pemphigus vulgaris is an autoantibody-mediated disease against desmoglein 3, and systemic corticosteroids remain first-line. Steroid-sparing agents such as azathioprine or mycophenolate are added for long-term control, and rituximab is now used in refractory disease.