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Pemphigus Vulgaris — SCE Dermatology MCQ

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ModerateBlistering DiseasesPemphigus VulgarisSCE Dermatology

A 45-year-old woman with pemphigus vulgaris on Prednisolone and Azathioprine develops new flaccid blisters on her trunk. Anti-desmoglein 1 titre has risen significantly from baseline. What does a rising anti-desmoglein 1 titre indicate?

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Correct answer: B — Disease relapse or flare — rising titres correlate with disease activity

Anti-desmoglein ELISA titres in pemphigus correlate with disease activity and can be used to monitor treatment response and predict relapse. Rising anti-Dsg1 titres indicate cutaneous disease activity (new skin blisters), while rising anti-Dsg3 titres correlate with mucosal disease. Serial monitoring helps guide treatment adjustments — escalation of immunosuppression may be needed if titres rise with clinical relapse. The combination of rising serology with new clinical disease confirms relapse rather than infection or drug side effects.

Reference: BAD 2017 Pemphigus Guidelines; EADV 2020