A patient with known pemphigus vulgaris (PV) presents with widespread flaccid bullae, multiple erosions, and fever. Her Nikolsky sign is strongly positive. She cannot eat due to oral pain. What is the immediate treatment priority that reduces mortality in this acute flare?

• A Start rituximab 1000 mg IV and wait for response
• B Plasmapheresis alone as first-line
• C Dapsone 100 mg daily
• D High-dose systemic corticosteroids (prednisolone 1.5 mg/kg/day) with fluid and electrolyte replacement ✓

Explanation

Acute pemphigus flares remain a dermatological emergency with significant mortality from sepsis and fluid loss. High-dose systemic corticosteroids (prednisolone 1–1.5 mg/kg/day or equivalent) remain the cornerstone of immediate management, combined with aggressive fluid and electrolyte replacement, nutritional support, and wound care. Rituximab is now first-line for newly diagnosed moderate-severe PV per recent guidelines but takes weeks to act — systemic corticosteroids provide rapid disease control in the acute emergency. Dapsone is used in dermatitis herpetiformis, not PV.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.