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BACKGROUND: Pemphigus vulgaris (PV) is a rare, potentially life-threatening, autoimmune bullousdisease with considerable age and gender variation, high incidence of relapse and an unpredictableprogression and prognosis.OBJECTIVE: To determine the factors leading to relapse of disease in pemphigus vulgaris patients.METHODOLOGY: This case series was conducted at Lady Reading Hospital, Peshawar. A total of 80consecutive patients who presented with a relapse over a two year period (2013-2015) were included inthe study. Relevant information including biodata, number of relapses, and cause of relapse like poordrug compliance, faulty tapering, infection, pregnancy & uncontrolled diabetes were collected from thepatients. Analysis was done in SPSS version 20.RESULTS: The mean age of patients presenting with a relapse was 38.08 + 14.5 years with minimumage of 10 years and maximum of 80 years. The male to female gender ratio was 2:1 with 67.5% malesand 32.5% females. The causes identified for relapse were Poor drug Compliance in 46.3% patients,Faulty Tapering in 30% patients ,unknown cause in 8.8%,Infection in 7.5% patients. Pregnancy in 3.8%patients and Uncontrolled Diabetes Mellitus in3.8% patients. Patients had multiple relapses varyingfrom one to more than three.CONCLUSION: The most common cause of relapse in pemphigus patients is poor drug compliancefollowed by faulty corticosteroid tapering. Most of these cases are of middle age with a malepredominance and present to us during the second relapse.KEY WORDS: pemphigusvulgaris, relapse, compliance, faulty tapering, infection.