Outcome of pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris can be divided into mucosal, mucocutaneous and cutaneous subtypes. A higher mortality rate has been shown with mucocutaneous involvement. OBJECTIVES: The aim of this retrospective study was to analyse the association of clinical subtypes of pemphigus vulgaris with remission rates. PATIENTS/METHODS: One hundred twenty-eight patients with pemphigus vulgaris, treated with prednisolone 2 mg/kg/day plus azathioprine 2 to 2.5 mg/kg/day, were enrolled. The partial and complete remission rates, at the end of the first and second years of treatment, and the number of relapses were compared in the three groups. RESULTS: After disease establishment, 71.1% had mucocutaneous, 18.8% had mucosal, and 10.2% had only cutaneous involvement. The mean duration of follow-up was 53.5 +/- 39.6 months. The mean duration it took the mucocutaneous group to reach a prednisolone dosage of 30 mg/day was significantly longer (P = 0.050). Mucocutaneous patients had a significantly lower rate of remission (31.9%) compared with those with only mucosal or cutaneous involvement (48.6%) at the end of the first year of the treatment (P = 0.029). After 2 years, mucocutaneous patients again had a lower remission rate (32.9% vs. 44.5%). Relapses were also more frequent in this subtype. Those presenting with mucosal or mucocutaneous erosions had a higher rate of active disease after receiving treatment for a year compared with those with only cutaneous presentation (66.7% vs. 45%; P = 0.057). CONCLUSIONS: In mucocutaneous subtype, clinical control was achieved later, and they had a lower rate of remission at the end of the first and second years of treatment. They were also prone to relapses.

Persistent periorbital edema as a sole manifestation of cutaneous lupus erythematosus: report of two cases.

In lupus erythematosus, dramatic periorbital edema and erythema without any evidence of other significant cutaneous or systemic involvement is unusual. We describe two patients with severe periorbital edema and erythema as the sole manifestation of cutaneous lupus erythematosus.

An electrochemical platform for localized pH control on demand.

Solution pH is a powerful tool for regulating many kinds of chemical activity, but is generally treated as a static property defined by a pre-selected buffer. Introducing dynamic control of pH in space, time, and magnitude can enable richer and more efficient chemistries, but is not feasible with traditional methods of titration or buffer exchange. Recent reports have featured electrochemical strategies for modifying bulk pH in constrained volumes, but only demonstrate switching between two preset values and omit spatial control entirely. Here, we use a combination of solution-borne quinones and galvanostatic excitation to enable quantitative control of pH environments that are highly localized to an electrode surface. We demonstrate highly reproducible acidification and alkalinization with up to 0.1 pH s(-1) (±0.002 pH s(-1)) rate of change across the dynamic range of our pH sensor (pH 4.5 to 7.5) in buffered solutions. Using dynamic current control, we generate and sustain 3 distinct pH microenvironments simultaneously to within ±0.04 pH for 13 minutes in a single solution, and we leverage these microenvironments to demonstrate spatially-resolved, pH-driven control of enzymatic activity. In addition to straightforward applications of spatio-temporal pH control (e.g. efficiently studying pH-dependencies of chemical interactions), the technique opens completely new avenues for implementing complex systems through dynamic control of enzyme activation, protein binding affinity, chemical reactivity, chemical release, molecular self-assembly, and many more pH-controlled processes.

Pemphigus and associated environmental factors: a case-control study.

BACKGROUND: Recent reports have revealed the relatively high incidence of pemphigus in Iran. Occupational exposure and personal habits have been suggested to play a role in the aetiopathogenesis of this life-threatening disease. AIM: In order to analyse the association of environmental factors with pemphigus, we conducted a case-control study to evaluate the possible role of smoking, pesticide exposure and hormonal factors in Iran. METHODS: This study was conducted in Iran using a structured questionnaire. Questions included information on patients' smoking habits, occupational exposure to pesticides, use of oral contraception (OC) and number of pregnancies. RESULTS: We enrolled 210 patients with pemphigus and 205 control subjects. Fewer of patients with pemphigus (17.1%) reported a current or past history of smoking, which was statistically different from the control group (27.3% smokers). The duration of smoking and the number of cigarettes smoked daily was also significantly lower in patients. Although OC use was significantly higher in women with pemphigus, the mean number of pregnancies was not different between the two groups. Occupational exposure to pesticides was significantly higher in patients with pemphigus (14.8%) than in controls (5.4%); patients with pemphigus were exposed to pesticides three times more often than were healthy subjects. CONCLUSION: As a positive history of smoking was lower in patients with pemphigus compared with healthy subjects, it seems that smoking is a protective factor in pemphigus. This should encourage further investigations, searching for novel therapies. If pesticides and OC are confirmed as triggering factors, their cessation might reduce the need for pharmacological therapy.