Comparative Study to Assess the Safety and Efficacy of Topical Pilocarpine versus Topical Triamcinolone in the Treatment of Oral Pemphigus Vulgaris

Background: Oral mucosa is typically the most frequent site of involvement in pemphigus vulgaris (PV). Currently, the mainstay in the treatment of oral erosions is topical corticosteroid. Topical pilocarpine has been tried in oral PV, based on the cholinomimetic property of pilocarpine, which is known to block the process of blister formation. Objectives: We aimed (1) to study the healing effect of pilocarpine 2% paste in oral PV and (2) to compare the efficacy of topical pilocarpine versus topical triamcinolone in oral pemphigus. Materials and Methods: A total of 30 subjects receiving treatment for PV were randomized into two groups. Group A was treated with topical triamcinolone 0.1% paste and Group B with topical pilocarpine 2% paste. The oral Pemphigus Disease Area Index score and epithelization index were calculated before and after the treatment interval. Results: Analysis of results showed a significant reduction in disease severity and lesional area with topical pilocarpine paste. A higher epithelization index was noted with topical pilocarpine as compared to topical triamcinolone. Limitations: This study is limited by its small sample size, short follow-up duration, and single-center design. The assessment of the erosion area was subjective, relying on visual clinical evaluation. Thus, further large-scale studies on diverse populations are required to validate these findings. Conclusion: In the early phase of pemphigus pathogenesis, anti-acetylcholine receptor antibodies block signaling essential for intercellular adhesion. Pilocarpine, a muscarinic acetylcholine agonist, serves as a potential alternate therapy to corticosteroid for oral PV.