title: Think globally, act locally: expert opinions from Asia on the diagnosis and treatment of pemphigus vulgaris.
abstract: BACKGROUND
  Pemphigus vulgaris (PV) is the most common blistering disease in Iran and many other Asian countries with a relatively high incidence and involvement of both skin and mucous membranes in majority of the patients.
  
  
  OBJECTIVE
  To assess the opinions of Asian experts on the diagnosis and management of PV.
  
  
  METHODS
  It was a questionnaire-based mailed/e-mailed survey.
  
  
  METHODS
  The questionnaire was sent to 29 dermatologists from different countries of Asia who treat autoimmune blistering disorders, with at least 5 years' experience in this field and who visit at least five new PV patients annually. Questions included duration of experience, number of patients treated and diagnostic and treatment approaches for PV.
  
  
  METHODS
  Percentage prevalence; some data are reported as mean +/- SD.
  
  
  RESULTS
  All of the 29 physicians participated in the survey; among them, 79.3% visit their patients within 6 months after the onset of symptoms. Diagnosis of PV is confirmed by histologic and direct immunofluorescence examinations by 65.5% of physicians. All of them initiate the treatment with corticosteroids (48.3% with a dose of at least 2 mg/kg/day prednisolone) and 89.7% add adjuvant immunosuppressors at the same time. Of the adjuvant agents used, azathioprine is used by 82.8% of physicians.
  
  
  CONCLUSIONS
  Different trends in diagnostic techniques and treatment options for PV among the experienced authorities emphasize the urgent need for large-scale controlled trials in order to reach consensus standards in this field. In addition, regional and worldwide consensus meetings to consider all regional and genetic similarities and differences are highly recommended.
authors.affiliation: Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zeynab
authors.initials: Z
authors.lastname: Samadi
authors.forename: Farzam
authors.initials: F
authors.lastname: Gorouhi
authors.forename: Parastoo
authors.initials: P
authors.lastname: Davari
authors.forename: Alireza
authors.initials: A
authors.lastname: Firooz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001208:Asia; D001379:Azathioprine / Q000627:therapeutic use*; D032921:Consensus; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D010392:Pemphigus / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D001379:Azathioprine