Oral Pemphigus Vulgaris: The Importance of Patient's Adherence

Background: Pemphigus vulgaris (PV) is an autoimmune mucocutaneus disease characterized by intraepithelial bulla formation involving the oral mucosa. The treatment requires long-term corticosteroid at variable doses according to the severity of the lesion. Case report: A 41-years-old male was referred from the Dermatology Department with oral manifestations of PV. He was treated with systemic methylprednisolone. Oral examination showed severe intra oral PV lesion so that an additional of dexamethasone mouth rinse was prescribed. After 4 weeks of treatment, oral and systemic lesions were relieved. At that time the patient believed he has recovered and decided to stop the medication by himself. Several months later, his skin and oral lesion relapsed with more severe clinical condition than the previous one and he was re-treated with corticosteroid. The severity of PV was suspected by the lack of adherence in medication. Conclusion: Discontinuation of corticosteroids without a rational reason might influence the recurrence and severity of PV. Good adherence toward corticosteroid therapy is an important factor in PV treatment.