Pemphigus in remission: value of negative direct immunofluorescence in management.
BACKGROUND
Pemphigus vulgaris is characterized by relapses and remission, and there are currently no sensitive markers to predict remission.


OBJECTIVE
Our purpose was to determine if direct immunofluorescence (DIF) performed during clinical remission of pemphigus is useful in management of the disease.


METHODS
Twenty-eight patients with pemphigus that was in clinical remission (i.e., patients who were taking low-dose prednisolone [10 mg/day] and had been blister-free for at least 6 months) underwent DIF. Therapy was then discontinued and patients were prospectively followed up for 5 years.


RESULTS
Twenty-two patients had negative results and six patients had positive results of DIF. The disease remained in remission in three quarters of the patients with negative results of DIF. Of those who had a relapse, intercellular C3 on DIF and oral lesions on initial presentation were important risk factors, and the relapses in patients with negative results of DIF were mild. The biopsy site was unimportant. All patients with positive results of DIF had major relapses within 3 months of cessation of therapy.


CONCLUSIONS
DIF should be performed before therapy is discontinued. A negative DIF finding is a good indicator of remission in pemphigus.
Ratnam
K V
KV
National Skin Centre, Singapore.
Pang
B K
BK
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003176:Complement C3 / Q000378:metabolism; D005260:Female; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers; D003176:Complement C3; D011239:Prednisolone