Derm Cases · General Medicine
OSCE — Pemphigus Vulgaris & Bullous Pemphigoid
Eight-minute OSCE station on Pemphigus Vulgaris & Bullous Pemphigoid: focused history, examination priorities, investigations, emergency and definitive management.
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Study tools
Target exams
Brief (to candidate)
You will assess a patient with a presentation consistent with Pemphigus Vulgaris & Bullous Pemphigoid.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are the two archetype autoimmune blistering diseases of the skin and mucosa, distinguished by the level of the split and the target antigen. PV: pathogenic IgG against desmoglein 3 (Dsg3, mucosal) ± desmoglein 1 (Dsg1, cutaneous) → suprabasal intraepidermal acantholysis → flaccid blisters, raw erosions, oral ulceration, positive Nikolsky sign; affects middle-aged adults (40 to 60), Mediterranean/Jewish/Indian predilection; potentially fatal without immunosuppression. BP (commonest autoimmune blistering disease overall, and especially in the elderly): IgG against BP180 (BPAG2) and BP230 (BPAG1) of the hemidesmosome → subepidermal split → ten
[2]Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Flaccid blisters, widespread erosions, oral ulceration, positive Nikolsky sign — |
| Safety | Tense bullae on flexural skin in an elderly patient without oral involvement — b |
| Safety | Extensive pemphigus with skin loss — manage like a burn: burn unit/ICU, fluid-el |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1]
References3ShowHide
- [1]Murrell DF, Peña S, Joly P, et al. Diagnosis and management of pemphigus: Recommendations of an international panel of experts J Am Acad Dermatol, 2020.PMID 29438767
- [2]Rai R, et al. Anti-P 200 pemphigoid - The most common floor binding subepidermal autoimmune bullous disease in a tertiary care center in south India Indian J Dermatol Venereol Leprol, 2021.PMID 34160166
- [3]Hussain MH, Tanweer F, Sakagiannis G. Pemphigus Vulgaris and Bullous Pemphigoid of the Upper Aerodigestive Tract: A Review Article and Novel Approaches to Management ORL J Otorhinolaryngol Relat Spec, 2021.PMID 33902048