What is the initial management concern for pemphigus vulgaris?

• A. Observation
• B. Antibiotics only
• C. Stabilizing the patient (may require hospitalization)
• D. Immediate surgical excision

Answer: (C)

Stabilizing the patient is the essential first step because pemphigus vulgaris involves widespread autoimmune blistering that can cause significant fluid loss, dehydration, electrolyte disturbances, malnutrition, and a high risk of infection. This situation often requires hospitalization to provide IV fluids, careful electrolyte and nutritional support, wound care, and close monitoring while systemic immunosuppressive therapy is started. Relying on observation alone misses the urgent physiologic needs and the ongoing autoimmune process. Antibiotics may be necessary for infection but do not treat the underlying disease, and immediate surgical excision is not appropriate since the lesions are widespread and autoimmune-driven, not removable surgically.