Pemphigus Vulgaris — SCE Dermatology MCQ

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HardBlistering DiseasesPemphigus VulgarisSCE Dermatology

A 24-year-old woman is diagnosed with pemphigus vulgaris. She is started on systemic Prednisolone. Which steroid-sparing agent has the strongest evidence as first-line adjunctive therapy in pemphigus vulgaris?

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Correct answer: A — Rituximab

Rituximab (anti-CD20 monoclonal antibody) has emerged as a first-line treatment for pemphigus vulgaris alongside systemic corticosteroids based on the RITUX 3 trial, which showed superior complete remission rates compared to standard immunosuppression. BAD and EADV guidelines now support early use of Rituximab in moderate-to-severe pemphigus. Traditional steroid-sparing agents (Azathioprine, Mycophenolate) remain options but Rituximab demonstrates faster and more durable remission. IVIG is reserved for acute disease flares.

Reference: BAD 2017 Pemphigus Guidelines; EADV 2020; RITUX 3 Trial 2017