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Identification of factors associated with treatment refractoriness of oral lesions in pemphigus vulgaris
Author(s) -
Kumar S.,
De D.,
Handa S.,
Ratho R.K.,
Bhandari S.,
Pal A.,
Kamboj P.,
Sarkar S.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15658
Subject(s) - medicine , pemphigus vulgaris , refractory (planetary science) , refractory period , vitiligo , oral mucosa , gastroenterology , oral lichen planus , dermatology , pemphigus , prospective cohort study , pathology , physics , astrobiology
Summary Background The oral mucosal lesions of patients with pemphigus vulgaris are known to show more treatment refractoriness than skin lesions. Objectives To identify which clinical and laboratory parameters may indicate treatment refractoriness of oral lesions in pemphigus vulgaris. Methods This was a prospective study of 50 adults with pemphigus vulgaris and oral lesions; patients were given treatment appropriate for overall disease severity. Treatment refractoriness was defined arbitrarily as less than 75% reduction in oral objective Autoimmune Bullous Skin Disorder Intensity Score ( ABSIS ) after treatment for 6 months. Results Of 46 patients who completed the study, 17 (37%) were treatment refractory whereas 29 (63%) were treatment responsive. At baseline, the treatment refractory group had a significantly longer mean duration of disease ( P = 0·02) and mean duration of oral lesions ( P = 0·01), a higher percentage of lesions in the retromolar trigone ( P = 0·05) and on the occlusion line along the buccal mucosa ( P = 0·04), a higher percentage of deep/crateriform ulcers ( P < 0·001) and erosions with a lichenoid hue ( P < 0·001). Herpes simplex virus ( HSV ) DNA positivity, assessed by polymerase chain reaction in oral tissue scrapings ( P = 0·02), was also significantly higher in the treatment refractory group. No other factors we tested for were statistically significant. Conclusions Treatment refractoriness of oral lesions was significantly associated with duration of disease/oral lesions; specific morphology and location of oral lesions; and the presence of HSV DNA in the oral cavity. These factors may forewarn the treating physician about a refractory course of oral lesions that may help with counselling patients.