Pemphigus is a blister forming disease of both mucosa and skin of autoimmune origin. Most commonly seen in old age individuals and oral lesions precede the skin lesions in most cases. This is a report of a unique case of pemphigus vulgaris in an elderly male patient where oral lesions started initially followed by skin lesions. It was provisionally diagnosed by our oral medicine specialists on the very first visit and confirmed after a biopsy. The patient was treated successfully with systemic steroids and azathioprine with reduction in dose after 3 weeks. The healing was satisfactory and the patient is under follow-up.