IntroductionPemphigus vulgaris (PV) is a chronic, autoimmune, vesiculobullous disease. As a result of the relative rarity of PV, published randomized controlled trials (RCTs) are limited, which makes it difficult to evaluate the efficacy of different treatment regimens in this disease. This also precludes conduct of a meta-analysis.MethodsEnglish-language publications describing treatment outcomes of patients with PV were identified by searches of electronic databases through May 2015, and additionally by review of the bibliography of these publications. A total of 89 papers, which included 21 case reports, 47 case series, 8 RCTs, and 13 observational studies, were identified. The findings from these publications, including information on disease course and prognosis, medications used, treatment responses, and side effects, are summarized in the tables and text of this review.ResultsPrior to availability of corticosteroid therapy, PV had a high fatality rate. Early publications from the 1970s reported high-dose, prolonged corticosteroid use and significant associated side effects. Later reports described use of corticosteroids along with steroid-sparing adjuvants, which allows a reduction in the total dose of corticosteroids and a reduction in observed mortality and morbidity. For the majority of patients in these reports, a long-term course on medications lasting about 5–10 years was observed; however, subgroups of patients requiring shorter courses or needing longer-term therapy have also been described. Early diagnosis of PV and early initiation of treatment were prognostic factors. In recent publications, commonly used initial regimens include corticosteroids in combination with mycophenolate or azathioprine; whereas, for patients with inadequate response to these regimens, adjuvants such as intravenous immunoglobulin (IVIg) or rituximab are used.ConclusionThe review findings emphasize the importance of early diagnosis, early initiation of treatment, and use of steroid-sparing adjuvants to allow a reduced total dose and duration on corticosteroids. Also highlighted is the need for more RCTs.

Oral diseases are among the most common non-communicable diseases worldwide [1]. According to the Global Burden of Disease Study, untreated dental caries in permanent teeth was the most prevalent disease among 313 assessed conditions, affecting more than 530 million children [2]. Oral diseases are not only highly prevalent, but access to care varies based on the country of residence. Socioeconomic inequalities in access to oral health services ranges from 35% in low-income countries to 60% in lower-middle-income countries, 75% in upper-middle income countries and 82% in high-income countries [3]. Gaps initiatives to prevent oral diseases and improve access to healthy environments require better dental public health systems, strong local oral health research capacity and a well-trained dental health workforce. The number of dentists-scientists worldwide is decreasing as the new generation of dental students favor clinical paths [4]. Motivating young oral health professionals to either remain in academics (for junior faculty) or to dedicate their career to research (for students), needs to be supported by an infrastructure and environment that enables short, medium and long-term lines of research.

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