A Retrospective Study of Pemphigus in a Tertiary Care Centre in South India

Author(s): Simon Sheena Ann1

Pemphigus is a group of rare, life-threatening autoimmune bullous diseases of the
skin and mucosa which result in intraepidermal blistering. Associated autoimmune
conditions and the extensive mucocutaneous detachment impair the quality of life.
Immunosuppressive treatment adds to the morbidity in patients. We wanted to
assess the clinical presentation of pemphigus among the study subjects along with
the outcome of pemphigus patients with the extent of the disease and results of
pus culture.
Retrospective analysis of case records of patients with pemphigus in a tertiary care
hospital during a period of 3 years was done in 2015. Demographic data, clinical
findings, underlying medical disorders, details of deaths, investigation reports and
treatment details were recorded.
Common age group affected was 51-60 years (31.5 %) among a total of 54
pemphigus patients. There were 26 males and 28 (51. 9 %) females and in
majority of the patients (44.4 %) duration was less than 6 months. Out of 47
patients, oral mucosal involvement was grade 1 in 20 (37 %) cases, grade 2 in 12
(22.2 %) and in 15 (27.8 %) patients it was grade 3.Histopathological examination
showed suprabasal cleft in 82.1 %, subcorneal blister in 5.7 %, acantholytic cells
in 48.6 % and row of tombstone appearance in 9.4 %. Out of 36 patients, DIF
test reported intercellular IgG in 65 % and C3 in 50 % .Diabetes was found in 14
(25.9 %), candidiasis in 12 (22.2 %), thyroid disease in 6 (11.1 %) and
hypertension in 3 patients. Three patients died. Among 10 patients with more than
30 % body surface area involvement, 1 (10 %) patient died. Two (13 %) deaths
occurred among 15 patients in whom pus C&S was positive.
Pemphigus patients were of slightly higher (51 - 70 years) age group and the 3
patients died were females. Autoimmune disorders like diabetes and thyroid
disorders were found among many patients and their family members. Infection
could be an important cause of death, but no statistically significant association
was found in the present study.