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. 2018 Jun;35(3):293-298.
doi: 10.5114/pdia.2017.71267. Epub 2017 Nov 8.

Scalp involvement in pemphigus: a prognostic marker

Marta Sar-Pomian  1 , Marek Konop  1 , Kamila Gala  2 , Lidia Rudnicka  1 , Malgorzata Olszewska  1
Affiliations

Scalp involvement in pemphigus: a prognostic marker

Marta Sar-Pomian et al. Postepy Dermatol Alergol. 2018 Jun.

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.

Keywords: desmoglein; hair; hair follicle; remission; therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Correlation between PDAI scalp activity score and PDAI skin activity score at enrollment
Figure 2
Figure 2
Correlation between PDAI scalp activity score and anti-desmoglein 1 antibody concentration at enrollment
See this image and copyright information in PMC

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