British Association of Dermatologists' Guidelines for the Management of Pemphigus Vulgaris 2017

K.E. Harman; D. Brown; L.S. Exton; R.W. Groves; P.J. Hampton; M.F. Mohd Mustapa; J.F. Setterfield; P.D. Yesudian


The British Journal of Dermatology. 2017;177(5):1170-1201. 

In This Article

Recommended Audit Points

In the last 20 consecutive patients with PV, or all patients seen in the last 12 months (if fewer than 20), is there clear documentation of

1. Measurement of baseline parameters prior to starting treatment. As a minimum this should include

  • Weight

  • Blood pressure and whether there is a clinical history of hypertension

  • Height (children)

  • Blood glucose and HbA1c and whether there is a clinical history of diabetes

  • Pregnancy test (if appropriate)

  • Full blood count, renal and liver function tests.

2. Appropriate investigations to establish diagnosis. As a minimum this should include

  • A lesional skin/mucosal biopsy for routine histopathology

  • Perilesional skin/mucosal biopsy for DIF (alternatively, IIF or desmoglein ELISA if biopsy is not possible).

3. Evidence of appropriate drug monitoring. For patients on corticosteroids, as a minimum this should include regular measurements of or documentation of

  • Blood pressure

  • Weight

  • Blood glucose/HbA1c

  • Height (children)

  • Renal function

  • Evidence that gastric and bone prophylaxis is considered

  • Symptoms suggestive of important side-effects, for example peptic ulceration or visual decline. Other investigations are dependent on the choice of adjuvant drug but should include documentation of baseline investigations relevant to the drug in question and evidence of appropriate follow-up monitoring.

4. Adherence to guidelines for prophylaxis and management of steroid-induced osteoporosis.[82]

5. Use of objective disease-scoring methodologies to assess clinical outcomes, for example PDAI, ABSIS or the Oral Disease Severity Score.[31–35]

The usual audit recommendation of 20 cases per department is to reduce variation in the results due to a single patient, and to allow benchmarking between different units. However, departments unable to achieve this recommendation may choose to audit all cases seen in the preceding 12 months.


The full manuscript provides details of the evidence. Table 4 summarizes the treatment options for PV, highlighting certain practical and economic considerations. For an overview of PV management to serve as a brief summary of options for reference in the clinical setting see Table 1.