Clinical and immunological features of pemphigus relapse

Br J Dermatol. 2019 Jun;180(6):1498-1505. doi: 10.1111/bjd.17591. Epub 2019 Mar 6.


Background: More than half of patients with pemphigus experience relapse during the disease course. The risk factors and clinical and immunological characteristics of relapse remain largely unclear.

Objectives: To elucidate the risk factors and clinical features of pemphigus relapse.

Methods: We carried out a retrospective review of the clinical records of 42 cases of pemphigus at a single centre.

Results: Sixty-two per cent of patients experienced relapse, usually when oral prednisolone was tapered to around 0·1 mg kg-1 . In mucocutaneous pemphigus vulgaris (mcPV), the initial doses (mean ± SD) of prednisolone were significantly lower in patients with relapse (0·78 ± 0·24 mg kg-1 ) than in those without relapse (1·01 ± 0·01 mg kg-1 ). At relapse, mcPV shifted to mucosal dominant PV (mPV; 40%), pemphigus foliaceus (PF) (20%) or 'other' (20%). In contrast, relapsing mPV and PF had the same clinical phenotypes as the initial phenotypes. Patients with both anti-desmoglein (Dsg)1 and anti-Dsg3 antibodies at onset had recurrence with anti-Dsg3 antibodies alone (40%), with both anti-Dsg1 and anti-Dsg3 antibodies (30%), with anti-Dsg1 antibody alone (20%) or were subthreshold (10%).

Conclusions: mcPV shows transitions in clinical phenotype and autoantibody profile at relapse. At least 1 mg kg-1 daily of prednisolone, especially for patients with mcPV, and prudent tapering around 0·1 mg kg-1 may lead to better outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Autoantibodies / blood*
  • Autoantibodies / immunology
  • Desmoglein 1 / immunology
  • Desmoglein 3 / immunology
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pemphigus / blood
  • Pemphigus / diagnosis*
  • Pemphigus / drug therapy
  • Pemphigus / immunology
  • Prednisolone / administration & dosage*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult


  • Autoantibodies
  • DSG1 protein, human
  • DSG3 protein, human
  • Desmoglein 1
  • Desmoglein 3
  • Prednisolone