Derm: Pemphigus Vulgaris

-bullous disease of skin and mucous membranes -40-60 year olds
-autoimmune disease with immunoglobulin attacking bridges between epidermal cells
-starts in the mouth, then to the skin after several months
-very flacid bullae, which rupture and leave erosions behind--Nikolski's sign +
-mortality rate of 5% (was higher before steroids)
-Rx: high dose steroids (pred 2-3 mg/kg/day), immunosuppressive therapy (azathiaprine and methotrexate), antibiotics for secondary bacterial infxns
-dispo: consider admission if extensive involvement