Surgical approach to the treatment of refractory lesions of pemphigus vulgaris.

A patient with pemphigus vulgaris had lesions on the lip that proved to be refractory to intralesional corticosteroid therapy and to treatment with azathioprine and later to daily administration of 250 mg of prednisone. The patient developed marked cushingoid features and deep vein thrombosis, rendering the continuation of the prednisone therapy unadvisable . Total vermilionectomy of the affected lip was performed and the prednisone was gradually tapered, taking care that oral lesions remained under control. Eighteen months after the operation, the patient is receiving a single alternate-daily dose of 20 mg prednisone, and both the lip and oral lesions are in remission.