A 40-year-old man with a long-standing history of pemphigus vulgaris is seen for a routine follow-up visit. He is currently fairly well controlled with 30 mg prednisone every other day and 150 mg azathioprine daily. In addition to that, he takes glyburide, hydrochlorothiazide, nifedipine, a daily multivitamin, and occasional acetaminophen for headaches. His family history is significant for hypertension and diabetes. On physical examination the patient is in mild distress due to oral lesions that are painful when he talks or eats. His vital signs are within normal limits, and a complete blood count and electrolyte panel show no abnormal values. Inspection of the oral mucosa reveals multiple ulcers in various stages of healing. The skin has no active bullous lesions, but you note the appearance of the lesions shown in the photograph, which were not present at his last checkup.
He should be told which of the following?
A. Daily topical steroid application is indicated to hasten resolution of these skin lesions
B. Losing weight will most likely result in the disappearance of these skin lesions
C. These skin lesions will resolve once he is weaned off prednisone
D. He will not get any new skin lesions unless the dose of prednisone is increased
E. The skin lesions are permanent and their number will most likely increase with time if he continues his current treatment regimen
Click image to enlarge
He should be told which of the following?
A. Daily topical steroid application is indicated to hasten resolution of these skin lesions
B. Losing weight will most likely result in the disappearance of these skin lesions
C. These skin lesions will resolve once he is weaned off prednisone
D. He will not get any new skin lesions unless the dose of prednisone is increased
E. The skin lesions are permanent and their number will most likely increase with time if he continues his current treatment regimen
Click image to enlarge