Derm: Pemphigus vulgaris: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Pemphigus Vulgaris🎧 A clear, high-yield breakdown of this rare autoimmune blistering disease – perfect for exam prep and clinical recognition.🧠 Key Learning Points📌 Definition• Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder affecting the skin and mucous membranes, caused by autoantibodies against desmogleins—proteins vital for cell-to-cell adhesion.📌 Causes & Risk Factors• Autoantibodies against desmoglein 3 (and sometimes desmoglein 1)• Genetic predisposition (HLA-DR4, DR14)• Higher risk in Ashkenazi Jewish and Mediterranean populations• Middle-aged and older adults most commonly affected• Potential triggers: drugs, UV radiation, stress🧠 Mnemonic: “DESMO” – Desmoglein, Ethnicity, Steroids needed, Mucosa, Older adults📌 Pathophysiology• Autoantibodies (mainly IgG1 & IgG4) disrupt desmosomes, breaking keratinocyte adhesion• Leads to acantholysis → intraepidermal split• Results in fragile, superficial blisters📌 Symptoms• Painful, flaccid blisters on skin and mucosa• Oral erosions often appear first and may persist for weeks• Raw erosions from ruptured blisters – slow healing• Sites: scalp, face, chest, groin, oral cavity🧠 Not Itchy! – pain not pruritus helps distinguish from bullous pemphigoid📌 Differential Diagnosis• Bullous pemphigoid (itchy, tense blisters)• Herpes simplex, aphthous ulcers• Pemphigus foliaceus (no mucosal involvement)• Lichen planus, drug-induced bullae, dermatitis herpetiformis📌 Diagnosis• 🧪 Skin biopsy → acantholysis seen on histology• 💡 Direct immunofluorescence → “chicken wire” IgG around keratinocytes• 🔬 ELISA for anti-desmoglein 3 (±1) antibodies• Consider indirect immunofluorescence and baseline labs before treatment• Nikolsky sign positive – gentle rubbing causes epidermal shearing📌 Management• 💊 Systemic corticosteroids (e.g. oral prednisolone) – first-line• ➕ Add steroid-sparing agents: azathioprine, mycophenolate mofetil• 💉 Biologic therapy – rituximab increasingly used for moderate/severe cases• 🩹 Supportive care: pain relief, wound care, nutrition• 🧠 Monitor for side effects: osteoporosis, diabetes, infection📌 Complications• Secondary infections of skin erosions• Malnutrition from painful oral lesions• Steroid side effects – bone loss, Cushingoid changes, immunosuppression• Long-term immunosuppression risks – infection, malignancy📌 Prognosis• With treatment, prognosis is now greatly improved• Mortality once high, now significantly reduced• Long-term follow-up needed due to relapse risk and treatment side effects📎 More MSRA Resources for Pemphigus Vulgaris📝 Revision Notes:https://www.passthemsra.com/topic/pemphigus-vulgaris-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/pemphigus-vulgaris-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/pemphigus-vulgaris-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/pemphigus-vulgaris-rapid-quiz/🎯 Topic Quiz:https://www.passthemsra.com/quizzes/pemphigus-vulgaris/🎓 Full Course:https://www.passthemsra.com/courses/dermatology-for-the-msra/📣 Course MentionThis episode is part of the Dermatology for the MSRA course on PassTheMSRA.com.Explore full revision guides, quizzes, flashcards and more:👉 https://www.passthemsra.com#MSRA #PemphigusVulgaris #MSRADermatology #MSRARevision #MSRAFlashcards #MSRAQuiz #MSRAQandA #MSRATextbook #PassTheMSRA #MSRAOnlineRevision #AutoimmuneBlisters #NikolskySign #Desmoglein #MultiSpecialtyRecruitmentAssessment #MSRAPodcast