Clinical analysis of pemphigus vulgaris and pemphigus foliaceus: A review of 58 cases

Pemphigus is a potentially fatal disease if it becomes refractory to treatment modalities. We sought to evaluate the factors that might affect the prognosis of pemphigus vulgaris (PV) and pemphigus foliaceus (PF) and compare the clinical differences between them. We herein studied 58 patients with pemphigus (32 with PV; 26 with PF) who received biopsies and treatments from 1979 to 2002 in the Taipei Veteran General Hospital. Fifteen patients (9 PV and 6 PF patients, 25.9%) expired in the study. Complications occurred in the study are summarized as Cushing's syndrome, compression fracture of L-spine, upper gastrointestinal tract bleeding with tarry stool, oral candidiasis, cutaneous wound infection, pneumonia, acute renal failure, liver toxicity, and sepsis. Our results showed that the onset age, initial corticosteroid dosage, total drugs for pemphigus treatment and complication rate are significantly different between PV and PF. Furthermore, the numbers of complication directly affect the prognosis of the pemphigus patients. When we used complication number of one as reference group, an additional complication may increase the mortality risk by 2.2 folds (p = 0.002). Patients had a better prognosis if they survived longer than 18 months. We also observed a higher cancer comorbidity in the pemphigus patients compared with the general population.