Does Clinical Research Help Pemphigus Patients? Precautions and Suggestions

The review by Eleonora Ruocco et al. [1] in this issue of the journal offers a good documentation of the potential for clinical research to clarify the role of environmental factors in the development and triggering of pemphigus. In principle, non-pharmacological interventions may represent a mean to modulate disease severity. In the meantime, the review shows the limitations of our current knowledge. In fact, there is a general lack of reliable quantitative estimates of association for most of the proposed causal factors and a large part of the evidence presented comes from isolated case reports, in vitro data and previously published narrative reviews. A balance view on the role of environmental factors is of the outmost importance to physicians and their patients. This would require thoroughly considering the quality and strength of the evidence, and the possibility of generalizing the study results from benchside to bedside, from a single case report or a clinical series to the patients’ population or, more simply, from one geographic area to another. Although much has been learned about the pathogenesis of acquired blistering disorders, little is known about key events in the interplay of environmental and genetic factors of these disorders [2]. Risk Assessment