title: Stress and serum TNF-alpha levels may predict disease outcome in patients with pemphigus: a preliminary study.
abstract: The aim of the current preliminary case-control study was to estimate the initial serum levels of tumor necrosis factor alpha (TNF-alpha) in case patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF) and correlate them with history of stress, body surface area (BSA) affected, disease severity, and disease outcome. Ten PV and 4 PF case patients as well as 7 healthy matched controls had their serum levels of TNF-alpha measured by an enzyme-linked immunosorbent assay. Case patients were treated and followed up for 2 months. A statistically significant elevation in serum levels of TNF-alpha in PV case patients compared with controls and in PV case patients compared with PF case patients was detected (P < .05), with no significant difference between PF case patients and controls (P > .05). No significant correlation was detected between the serum levels of TNF-alpha and the BSA affected (P > .05). Four PV case patients had a bad disease outcome, of which 3 had severe emotional stress a month prior to the onset of the attack. All 4 showed significantly elevated initial serum levels of TNF-alpha compared with those who had a good disease outcome (P < .05). Emotional stress is a factor affecting prognosis of the disease. Pretreatment assessment of serum TNF-alpha levels in patients with pemphigus may be a guide to the expected prognosis and selection of the proper treatment regimen.
authors.affiliation: Department of Dermatology and Venereology, Ain Shams University Hospital, 32 Hassan Ibrahim Hassan, Nasr City, Cairo, Egypt 11371.
authors.forename: Nader
authors.initials: N
authors.lastname: Ragab
authors.forename: Marwa
authors.initials: M
authors.lastname: Abdallah
authors.forename: Eman
authors.initials: E
authors.lastname: El-Gohary
authors.forename: Rana
authors.initials: R
authors.lastname: Elewa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000097:blood* / Q000523:psychology*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000097:blood*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha