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RAMI REDDY MEMORIAL COLLEGE OF PHARMACY

DEPARTMENT OF PHARMACY PRACTICE, KADAPA

A CASE PRESENTATION ON
PEMPHIGUS FOLIACEUS

PRESENTED BY:
C.S.V. LAKSHMI PRASAD
19441T0005
PHARM-D 5th year

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 PATIENT DEMOGRAPHIC DETAILS:
Patient Name: Mrs . X

Age/Gender: 60years/female
Admission number: 26528
Department: Skin and DVL ward -1
Date of admission: 19-7-23
Date of discharge: 24-7-23
Name of consultant Doctor: Dr. Narvotham sir
Provisional/Admitting diagnosis: Fluid-filled lesions over the forehead.
Chief complaints: C/O of fluid-filled lesions over the forehead and upper back since 5
days associated with itching sensation.
Past medical history: K/C/O- thyroid disease and taking thyroxine-125mg.

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 SUBJECTIVE EVALUATION:
A 60-years old female patient was admitted to the skin and DVL ward with the chief complaints of fluid-filled lesions over the
forehead and upper back associated with the itching for 5 days, past medical history includes the presence of thyroid and
administration of thyroxine.
OBJECTIVE EVALUATION:
On general examination: The patient was conscious and coherent.
On physical examination: The patient has BP-108/75mmHg; RR-21cpm
PULSE-82 bpm; TEMP-Afebrile
On systemic examination : The dermatological findings revealed fluid filled lesions and itching sense.
On laboratory examinations: RBS – 130mgs/dl [80-120mgs/dl]
Hb – 11.2gm/dl [ 12-16gms/dl]
WBC- 6,500/cu mm [4,500- 11,000/cu mm]
TC- 86%, 11%, 2%, 1%
Platelet count- 4.4 lakhs [1.5 – 5 lakh]

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 OTHER DIAGNOSTIC DATA:
BIOPSY- It shows typical features of rounded up seperated keratinocytes [called acantholytic cells] within the
blisters in the upper layers of the epidermis.

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 ASSESSMENT:
Based on subjective and objective evaluation the patient was diagnosed with PEMPHIGUS FOLIACEUS.

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 DAY TO DAY PROGNOSIS:

PROGNOSIS TREATMENT

DAY-1 Rx :
1. Inj. Decadron- 2CC – IV – OD
2. Inj. CPM – 2CC- IM – BD
BP-108/75mmHg 3. Glycerin lotion – TID
4. Fusidic cream – OD
5. Oint. Betamethasone – OD
Pulse-82bpm 6. Cap. A&D – OD – 25mg
7. T. Rantac- 150mg
8. T. Amoxicillin – BD- 625mg
RR -21 cpm

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 PROGNOSIS TREATEMENT
DAY-2 Rx :
Patient was c/c 1)Inj. Decadron -2cc – IV –OD
PR- 80bpm 2)Inj. CPM -2cc – IM –BD
3)Glycerin lotion –TID
4)Tab. Rantac -150 mg OD
5)Fucidin cream – OD
6) Oint. Betamethasone OD
7)Cap A&D –OD – 25mcg
8) T. amoxicillin BD – 625mg

DAY-3 &DAY 4 Rx :
Patient was c/c Continued the same treatment

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 PROGNOSIS TREATMENT

DAY-5 Rx :
The patient was discharged with the following medication and 1)T. Prednisolone – 30mg –OD
asked for a review for 10 days.
2) T. Rantac – 40mg OD
3) Fusidic acid cream – OD
4) T. CPM –OD – 4Mmg
5)Oint. Betamethasone – OD
6) Cap A&D – 25mcg – OD

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 DRUG CHART
s. Drug name Indication Category Dose Route Freque No.of
no ncy days
given
1 T. Prednisolone allergies Corticosteriods 20mg PO OD Day1-5

2 T. Rantac gastric irritation H2receptor antagonist 150mg PO OD Day1-5

3 Cream Fusidic acid Infected Anti staphylococcal - Topical TID Day1-5

dermatitis antibiotic

4 T. CPM relieve from Antihistamine 4mg PO OD Day1-5

allergy

5 Oint.Betamethasone Itching Corticosteroids - Topical OD Day1-5

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S.NO Drug name Indication Category Dose Route Frequency No.of days
given

6 Cap. A&D vitamin and Nutritional 25mcg PO OD Day1-5

calcium supplement
deficiency

7 T . Amoxycillin Bacterial Penicillin 625 mg PO BD Day 1- 4

infections antibiotic

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 CLINICAL PHARMACIST CARE ISSUES:
The given prescription was found to be RATIONAL.

PATIENT COUNSELLING:
Regarding disease:

Pemphigus foliaceous is an autoimmune condition that causes painful and itchy blisters and sores on the skin,
most often on the face, scalp, and trunk. Symptoms include redness of the skin with an itching sensation.

Regarding Drugs:
1.T. Prednisolone is a corticosteroid given to reduce allergic conditions in a dose of 30mg once daily. It may
cause side effects such as feeling restless, indigestion, weight gain, and mild mood changes.
2. T. Rantac is an H2 receptor antagonist given to reduce gastric irritation in the dose of 40 mg once daily. It
may cause side effects such as headache, tiredness, constipation, sleepiness, and diarrhea.

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3. Fusidic acid is an antibiotic used to treat infections in the affected areas. Side effects includes skin itching, burning
sensation.

4. T.CPM is an antihistamine used to treat allergies given in the dose of 4mg once daily after taking food. Side effects
includes drowsiness, stomach upset, dry mouth.

5. Cap. A&D is an nutritional supplement given in dose of 1mg once daily after taking food. Side effects includes
swelling of face and lips, hives.
6. Oint. Betamethasone is an corticosteroid to treat itching and redness of the skin.Side effects include acne, skin colour
changes, tiny red rashes around the mouth.

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REGARDING LIFE STYLE MODIFICATIONS:-
As a pharmacist I advised following information to the patient

▪ Protect your skin from injury by applying sunscreen , insect repellents.

▪ Don’t pick at or scratch your skin .

▪ Treat wounds promptly and properly.

▪ Keep injuries covered until they heal by changing bandage daily.

▪ Wash your hands regularly.

▪ Maintain good oral and skin hygiene.

▪ Eating bland and soft food.

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DISUSSION
Definition:-

Pemphigus foliaceus is an autoimmune condition that causes painful and itching blisters and
sores on skin , most often on face, scalp. It is an blistering skin disease seen predominantly in elderly patients .
Etiology:-
Pemphigus foliaceus may be caused by drugs such as:
⮚ Penicillamine
⮚ Captopril
⮚ Auto immune disease involving Immunoglobulin G
⮚ Genetic factors
⮚ Usually occurs in men and women in middle and late adult hood

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SYMPTOMS :
⮚ Redness and ruptured rashes on the skin
⮚ Oral lesions appears on the skin
⮚ Occurance of erosions
⮚ Enlarged skin bullae
⮚ Crusting and oozing wounds
⮚ Fluid filled lesions
⮚ Red bumps on the epidermis

PATHOPHYSIOLOGY:
Genetic and immunological predisposition

Stem cells with immunosuppressive action , formation of auto antibodies , directed against desimosomal
glycoproteins present on the surface of keratinocyte , effectively inhibiting the adherence between cells.
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 Formation of intraepithelial bullae, rupture of bullae and mucosal ulceration.

Pemphigus foliaceus.

DIAGNOSIS:

✔ Skin Biopsy
✔ Direct immunofluorescence(DIF)
✔ ELISA Test
✔ Patient history
✔ Histopathology
RISK FACTORS:
• History of having myasthenia gravis
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RISK FACTORS:
 History of having myasthenia gravis
 Systemic lupus erythematous

 Prolonged usage of ACE inhibitors ,NSAID’s

 Family history with pemphigus

COMPLICATIONS:
o Infection of the skin
o Sepsis
o Secondary bacterial infection
o Hypoalbuminemia
o Fluid and electrolyte imbalance

TREATMENT:

Goals:
⮚ To reduce the symptoms
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⮚ To treat lesions and allergy
⮚ To improve the skin condition
❑ First line drugs:
❖ Corticosteroids
• Prednisone 10-60mg
• Methyl Prednisolone 4-40mg
• Dexamethasone 4-20mg
❖ Immunosuppressants
• Azathioprine 1.5-2.5mg
• Cyclosporin 2.5mg/kg
• Infliximab 5mg/kg
❖ Antibiotics
• Amoxicillin 250-500mg

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✔ REREFERENCES:
✔ www.dermnetnz.org
✔ www.drugs.commayoclinic.org
✔ https://emedicine.medscape.com

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THANK YOU

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