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| Figure # 1 illustrates the left buccal mucosa of a 40 year-old male with PV. Note the extensive ulcerations with ragged margins and epithelial slough. Other lesions are seen in the mandibular sulcus at the level of the molars. When apparently normal skin or oral mucosa of patients with PV is rubbed off with gauze, the epithelium will be easily detached. This is known as the Nikolsky sign. | Figure # 2 is a photo of the same patient taken two weeks after steroid therapy. Note the marked improvement of the lesions. In the past, PV had a mortality rate of around 90%, presently it is almost 10%. The treatment of pemphigus is aimed at suppressing the autoimmune reaction which produces the dissolution of the intercellular bindings. Systemic and topical corticosteroids as well as other anti-inflammatory drugs (immunosuppressive) are effective to control the clinical manifestations but not to definitely treat the disease. With advancing age the clinical manifestations, if treated, tend to diminish in severity. Additional therapy include either systemic or local antifungal therapy in order to control oral candidal infection which may supervene due to the immunosuppressive therapy. |