Comparative analysis of demographics and clinical outcomes in patients with pemphigus vulgaris and foliaceus with high versus normal anti-desmoglein levels post-complete remission.

Some patients with pemphigus continue to have elevated levels of desmoglein autoantibodies (Dsg Ab) even after achieving remission. Thus, it is crucial to gain a deeper understanding of these patients' demographics and clinical patterns to improve prognosis, prevent complications, and devise individualized management strategies. This study utilized electronic patient records from a dermatology registry, focusing on PV and PF patients (diagnosed based on clinical and histopathologic diagnosis which included DIF) who achieved complete remission. We analyzed demographic and clinical data, including age, gender, BMI, disease type, lesion onset location, disease duration, test results, anti-desmoglein levels, and previous treatments. For comparative analysis, patients were categorized into two groups based on their Dsg Ab levels (high vs. normal) 3 months post-remission. Of the 80 patients evaluated, 57.5% were female, averaging 48.66 years. Significant gender differences were observed in Dsg Ab1 antibody levels, with males more likely to test sustained positive (P = 0.037), though no such difference was found for Dsg Ab 3 (P = 0.167). No significant differences in age, BMI, or history of other diseases were found between patients with high versus normal Dsg Abs post-recovery. The average time to complete recovery was 27.34 months, with no significant difference in recovery time or relapse rates based on antibody levels. However, there was a notable difference in some variables, including PDAI score, mucosal involvement, the average dose of prednisolone after achieving complete remission and occurrence of infectious complications (only regarding Dsg Ab 3) between the two groups (P < 0.05). The study underscores the heterogeneity in the post-remission course of pemphigus patients regarding the persistence of high Dsg Ab levels in some individuals. These findings emphasize the need for a tailored approach to management and monitoring of patients. Further research into the mechanisms driving these differences could pave the way for more effective treatments and prognostic tools in pemphigus care.