Saha M.,St Johns Institute Of Dermatology |
Bhogal B.,St Johns Institute Of Dermatology |
Black M.M.,St Johns Institute Of Dermatology |
Cooper D.,and Center for Transplantation |
And 2 more authors.
British Journal of Dermatology | Year: 2014
Background Pemphigus typically has a chronic course, although there is great variability in disease duration (DD) and time taken to disease remission (DR) between individuals with the disease. The reasons for this are unclear. Objectives To explore the prognostic influence of epidemiological, clinical, immunological and genetic factors on disease course and remission in pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Methods This was a retrospective study of patients with PV and PF, recruited from a single UK centre. Direct and indirect immunofluorescence and enzyme-linked immunosorbent assay studies for antidesmoglein (Dsg) antibodies were used to assess immunological factors. Polymerase chain reaction with sequence specific primers (PCR-SSP) was used to assess the Class II human leukocyte antigen status of patients. Prognostic endpoints investigated were time to initial first DR and total DD. Results Ninety-five patients were recruited (79 PV and 16 PF). Patients of Indo-Asian origin were significantly associated with longer DD than White-British patients (P = 0·029). In addition, younger age at onset was associated with a worse prognosis in terms of DD: the mean age at presentation of patients with DD of < 5 years was 49 years (SEM = 3·4) compared with 40 years (SEM = 1·9) in those with DD > 5 years (P = 0·039). A higher initial intercellular antibody titre on normal human skin substrate was associated with a greater time to initial DR (P = 0·007) and high anti-Dsg 3 levels at baseline were associated with a longer total DD (P = 0·03). Conclusions Ethnic group, age at presentation, initial intercellular antibody titre and initial Dsg 3 antibody levels all had a significant impact on prognosis of pemphigus. What's already known about this topic? Pemphigus typically has a chronic course, although there is great variability in disease duration and time taken to disease remission between individuals with the disease. The reasons for this are unclear. Certain genetic, epidemiological, clinical and immunological factors may be implicated in prognosis of pemphigus. What does this study add? This is the first detailed exploration of prognostic factors in both PV and PF in a U.K. population. We have identified that ethnic group, age at presentation, initial intercellular antibody titre and initial desmoglein 3 antibody levels all had a significant impact on prognosis of pemphigus. © 2013 British Association of Dermatologists.