Scalp involvement in pemphigus: a prognostic marker.

ABSTRACT

INTRODUCTION: Scalp involvement in the course of pemphigus is observed in 16-60% of patients. AIM: To determine the prognostic significance of scalp involvement in pemphigus vulgaris and pemphigus foliaceus. MATERIAL AND METHODS: A total of 75 patients (46 with pemphigus vulgaris, 29 with pemphigus foliaceus) were included into this prospective study. The following clinical data were analyzed Pemphigus Disease Area Index, time to complete clinical remission and duration of complete clinical remission. Indirect immunofluorescence and enzyme-linked immunosorbent assay were performed to monitor serum pemphigus antibodies. RESULTS: Scalp involvement was observed in 30/46 (65.2%) patients with pemphigus vulgaris and 28/29 (96.6%) patients with pemphigus foliaceus. A positive correlation was found between scalp involvement and general disease severity as measured by the Pemphigus Disease Area Index (r = 0.7, p < 0.05). The time required to achieve a complete clinical remission in patients with and without scalp involvement was 39.1 ±47.1 and 9.1 ±7.8 months, respectively. The duration of complete clinical remission was 14.1 ±17.4 and 105.7 ±108.8 months, respectively. The respective time required to achieve serological remission was 37.7 ±58.5 and 15.5 ±18.8 months, whereas the duration of serological remission was 9.2 ±18.8 and 39.1 ±60.1 months, respectively. The average concentration of anti-desmoglein 1 autoantibodies was significantly higher in patients with scalp involvement compared to patients without scalp involvement (109.9 ±68.0 U/ml and 21.3 ±39.4 U/ml). CONCLUSIONS: Scalp involvement in pemphigus is associated with a higher disease severity, longer time required to achieve complete clinical and serological remission and may indicate the need for a more aggressive therapeutical approach.