A full-term newborn born to a mother with inadequately treated pemphigus vulgaris develops flaccid blisters and superficial erosions on the trunk within hours of birth. The baby is feeding well and is systemically stable. Direct immunofluorescence shows intercellular IgG. What is the most appropriate management?

• A Exchange transfusion
• B Systemic prednisolone 1 mg/kg/day
• C Rituximab infusion
• D Supportive care, expecting spontaneous resolution within 2 to 3 weeks ✓

Explanation

Neonatal pemphigus results from passive transplacental transfer of maternal IgG4 anti-desmoglein antibodies. Because these antibodies are catabolised by the infant over roughly 2 to 3 weeks, the eruption heals spontaneously with supportive wound care, and immunosuppression is unnecessary. Systemic steroids or rituximab are reserved for severe extensive cases, and exchange transfusion is historical. The mother, however, requires adequate treatment before future pregnancies, as recurrence is likely if she remains uncontrolled.

Reference: Bolognia, Dermatology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.