PEMPHIGUS IN REMISSION - VALUE OF NEGATIVE DIRECT IMMUNOFLUORESCENCE IN MANAGEMENT

Background: Pemphigus vulgaris is characterized by relapses and remiss ion, and there are currently no sensitive markers to predict remission . Objective: Our purpose was to determine if direct immunofluorescence (DIF) performed during clinical remission of pemphigus is useful in m anagement of the disease. Methods: Twenty-eight patients with pemphigu s that was in clinical remission (i.e., patients who were taking low-d ose prednisolone [10 mg/day] and had been blister-free for at least 6 months) underwent DIF. Therapy was then discontinued and patients were prospectively followed up for 5 years. Results: Twenty-two patients h ad negative results and six patients had positive results of DIF. The disease remained in remission in three quarters of the patients with n egative results of DIF. Of those who had a relapse, intercellular C3 o n DIF and oral lesions on initial presentation were important risk fac tors, and the relapses in patients with negative results of DIF were m ild. The biopsy site was unimportant. All patients with positive resul ts of DIF had major relapses within 3 months of cessation of therapy. Conclusion: DIF should be performed before therapy is discontinued. A negative DIF finding is a good indicator of remission in pemphigus.