Identification of factors associated with treatment refractoriness of oral lesions in pemphigus vulgaris*

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SummaryBackgroundThe oral mucosal lesions of patients with pemphigus vulgaris are known to show more treatment refractoriness than skin lesions.ObjectivesTo identify which clinical and laboratory parameters may indicate treatment refractoriness of oral lesions in pemphigus vulgaris.MethodsThis 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.ResultsOf 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.ConclusionsTreatment 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.What's already known about this topic?Oral lesions in patients with pemphigus vulgaris show more treatment refractoriness than skin lesions.There is a paucity of literature regarding the role of various clinical and laboratory factors in the treatment refractoriness of oral lesions.What does this study add?Several factors may be associated with the treatment refractoriness of oral lesions.These include total duration of disease; duration of oral lesions; location of lesions in the retromolar trigone or along the occlusion line of the buccal mucosa; morphology of lesions in the form of deep/crateriform ulcers or erosions with lichenoid hue; and presence of herpes simplex virus DNA on polymerase chain reaction.What is the translational message?Identification of clinical and laboratory features associated with treatment refractoriness is important for appropriate counselling and treatment planning.Linked Comment: Yuan and Pan. Br J Dermatol 2017; 177:1476–1477.Plain language summary available onlineRespond to this article

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