Objective: To investigate the efficacy of a combined protocol of constant (monthly) clinical observation and structured diet therapy in preventing clinical relapses of pemphigus vulgaris (PV) in patients in remission within the Andijan region. Methods: A 24-month, prospective, controlled cohort study was conducted at the Andijan Regional Dermatovenerological Dispensary. We enrolled 110 PV patients who were in complete clinical remission (on ≤10mg/day prednisone or off therapy). Patients were allocated into two groups. The Intervention Group (IG, n=55) received a strict protocol of: 1) constant, mandatory monthly clinical examinations (oral and cutaneous) and 2) structured diet therapy, involving the strict elimination of thiol-containing foods (e.g., garlic, onion, leeks), strong spices, and highly acidic foods. The Control Group (CG, n=55) received the standard of care (SOC) for the region: clinical follow-up every 3-6 months, or as-needed (PRN) if a relapse was suspected, with standard dietary advice. Results: At 24 months, the clinical relapse rate in the Intervention Group (IG) was 21.8% (12/55 patients). This was significantly lower than the relapse rate in the Control Group (CG), which was 52.7% (29/55 patients; p < 0.001). Furthermore, the relapses observed in the IG were predominantly mild (oral) and detected early during monthly visits, requiring only topical or minimal oral steroid pulses. In contrast, 18 of the 29 relapses in the CG were moderate-to-severe, requiring significant systemic therapy escalation. The mean cumulative prednisone dose over 24 months was significantly lower in the IG (3,850 mg) compared to the CG (8,120 mg; p < 0.01). Conclusion: A structured, non-pharmacological program combining constant clinical observation with proactive diet therapy is a highly effective, low-cost strategy for preventing pemphigus relapses in a regional setting. This approach facilitates early detection of "micro-relapses," significantly reduces relapse rates, and minimizes long-term corticosteroid toxicity.

Pemphigus Vulgaris, Relapse, Prevention, Diet Therapy, Clinical Observation, Thiols, Andijan Region, Prophylaxis, Corticosteroid Sparing.

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