title: Trauma-induced pemphigus: a case series of 36 patients.
abstract: OBJECTIVE
  Pemphigus is a group of autoimmune diseases characterized by intraepidermal acantholytic blisters. Isomorphic responses, or Koebner phenomenon (KP), defined as the appearance of typical lesions of a disease following trauma are rarely reported in pemphigus. Our aim was to present patients who developed new pemphigus lesions as a result of skin trauma.
  
  
  METHODS
  The medical files of pemphigus patients from the Autoimmune Bullous Diseases Research Center, who had a history of trauma before the onset or flare of their disease, between 1999 and 2013 were reviewed.
  
  
  RESULTS
  Thirty-six pemphigus vulgaris (PV) patients had a history of trauma. Thirteen patients developed new-onset PV and the other 23 had previously been diagnosed with PV. Pemphigus lesions developed most often following major surgeries including abdominal, orthopedic, and chest surgeries as well as dental procedures, blunt physical trauma, and skin surgeries. Moreover, post-cataract laser surgery, burns, radiation therapy, and physiotherapy were also shown to induce pemphigus. Mean time between trauma and lesions was 4.7 weeks for recurrent PV and 15.0 weeks for new-onset PV.
  
  
  CONCLUSIONS
  Unnecessary surgery and blunt trauma should be avoided in pemphigus patients. Furthermore, posttraumatic pemphigus should be suspected in poorly healing surgical wounds and confirmatory biopsies are mandatory.
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Daneshpazhooh
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Fatehnejad
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ziba
authors.initials: Z
authors.lastname: Rahbar
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Balighi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Ghandi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghiasi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Robabeh
authors.initials: R
authors.lastname: Abedini
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vahideh
authors.initials: V
authors.lastname: Lajevardi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Cheyda
authors.initials: C
authors.lastname: Chams-Davatchi
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications* / Q000175:diagnosis; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D022125:Lacerations; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010392:Pemphigus / Q000175:diagnosis / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D012867:Skin / Q000293:injuries* / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis