History:

A young patient has had Pemphigus vulgaris since 4 years. The onset started with painful oral erosions and dysphagia in addition to multiple flaccid bullae and painful erosions in body flexures and trunk. Oral prednisolone (60 mg/ day) controlled the disease at start but later many exacerbations had occurred. Immuran 150 mg/day had been added but for 6 months did nothing beneficial to therapeutic response. It was stopped and methotrexate (started with 15 mg/ week) had been substituted and within two months good control of the condition with no appearance of new lesions had been reached. Gradual decrement of the dosage had been planned to reach a maintenance dose of 20 mg/ day prednisolone and 7.5 mg MTX per week. At last month the patient by himself reduced prednisolone to 10 mg/ day with a new exacerbation occurred. Some of the unavoidable side effects of the corticosteroids and sequel of the treated disease are evident in this patient like the Cushinoid appearance, striae, post-inflammatory hyperpigmentation and oral candidiasis.