Pemphigus is a chronic autoimmune blistering disorder where the immune system attacks keratinocyte adhesion proteins, leading to fragile blisters and erosions on the skin and mucosa.
Mnemonic: "P.E.M.P.H.I.G.U.S. = Painful Erosions, Mucosal,
Positive Nikolsky, Histology IgG, Unhealing Sores"
TYPES OF PEMPHIGUS
- Pemphigus Vulgaris (Most Common, Severe, Mucosal Involvement).
- Pemphigus Foliaceus (Superficial, No Mucosal Involvement).
- Paraneoplastic Pemphigus (Associated with Malignancies).
Mnemonic: "V.F.P." (Vulgaris, Foliaceus, Paraneoplastic)
CAUSES & PATHOGENESIS OF
PEMPHIGUS
- Autoimmune Attack (IgG Autoantibodies Against Desmogleins).
- Loss of Keratinocyte Adhesion (Acantholysis).
- Genetic Predisposition (HLA-DR4, HLA-DR14).
- Triggered by Drugs (Penicillamine, ACE Inhibitors, NSAIDs).
Mnemonic: "A.L.G.T." (Autoimmune, Loss of Adhesion,
Genetic, Triggers)
SYMPTOMS OF PEMPHIGUS
- Painful, Fragile Blisters on Skin & Mucosa.
- Oral Ulcers (Earliest Sign in Pemphigus Vulgaris).
- Blisters Rupture Easily → Leaves Raw, Eroded Skin.
- Scalp, Face, Chest, Back, Groin Commonly Affected.
Mnemonic: "B.O.B.S." (Blisters, Oral Ulcers, Burst
Easily, Skin Erosion)
SPECIAL SIGNS IN PEMPHIGUS
- Nikolsky’s Sign → Rubbing the skin causes epidermis to peel off.
- Asboe-Hansen Sign → Gentle pressure on a blister spreads fluid to surrounding areas.
Mnemonic: "N.A." (Nikolsky’s = Negative Adhesion,
Asboe-Hansen = Adjacent Spread)
DIFFERENTIAL DIAGNOSIS
- Bullous Pemphigoid (Tense Blisters, Nikolsky Negative).
- Dermatitis Herpetiformis (Grouped, Itchy Blisters).
- Erythema Multiforme (Target Lesions, No Acantholysis).
- Steven-Johnson Syndrome (Mucosal Involvement, Drug-Induced).
Mnemonic: "B.D.E.S." (Bullous Pemphigoid, Dermatitis
Herpetiformis, Erythema Multiforme, SJS)
DIAGNOSIS OF PEMPHIGUS
- Skin Biopsy (Acantholysis, Suprabasal Clefting).
- Direct Immunofluorescence (IgG & C3 Deposits in Epidermis).
- ELISA (Detects Anti-Desmoglein Antibodies).
Mnemonic: "B.I.E." (Biopsy, Immunofluorescence, ELISA)
TREATMENT OF PEMPHIGUS
1. MEDICAL MANAGEMENT
- High-Dose Corticosteroids (Prednisolone – 1st Line).
- Immunosuppressants (Azathioprine, Mycophenolate Mofetil).
- Rituximab (Monoclonal Antibody Against B-Cells).
- Plasmapheresis (Removes Circulating Autoantibodies in Severe Cases).
- Antibiotics (If Secondary Infection Present).
Mnemonic: "C.I.R.P.A." (Corticosteroids,
Immunosuppressants, Rituximab, Plasmapheresis, Antibiotics)
HOMOEOPATHIC MANAGEMENT OF
PEMPHIGUS
- For Painful Blisters & Burning Sensation:
- Cantharis, Rhus Tox, Arsenicum Album, Mezereum.
- For Severe Ulcerations & Raw Skin:
- Merc Sol, Hepar Sulph, Kali Bich.
- For Autoimmune Skin Conditions:
- Sulphur, Thuja, Psorinum, Natrum Mur.
Mnemonic: "C.R.A.M. – Cantharis, Rhus Tox, Arsenicum, Mezereum
for Blisters"
FINAL REVISION WITH MNEMONICS
- Definition = "P.E.M.P.H.I.G.U.S. = Painful Erosions, Mucosal, Positive Nikolsky, Histology IgG, Unhealing Sores"
- Types = "V.F.P." (Vulgaris, Foliaceus, Paraneoplastic)
- Pathogenesis = "A.L.G.T." (Autoimmune, Loss of Adhesion, Genetic, Triggers)
- Symptoms = "B.O.B.S." (Blisters, Oral Ulcers, Burst Easily, Skin Erosion)
- Signs = "N.A." (Nikolsky’s = Negative Adhesion, Asboe-Hansen = Adjacent Spread)
- Differential = "B.D.E.S." (Bullous Pemphigoid, Dermatitis Herpetiformis, Erythema Multiforme, SJS)
- Diagnosis = "B.I.E." (Biopsy, Immunofluorescence, ELISA)
- Treatment = "C.I.R.P.A." (Corticosteroids, Immunosuppressants, Rituximab, Plasmapheresis, Antibiotics)
- Homeopathy = "C.R.A.M." (Cantharis, Rhus Tox, Arsenicum, Mezereum for Blisters)
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