Laryngeal and nasal involvement in pemphigus vulgaris

Background: The presence of lesions of pemphigus vulgaris in the larynx and nasal cavity has been reported in individual case reports. However, the fr equency with which these sites are involved is not known. Objective: Our purpose was to investigate the incidence of laryngeal and na sal disease involvement in patients with pemphigus vulgaris. Methods: This was a retrospective analysis conducted in a referral private practice in an academic department of dermatology. A total of 53 sequential patients with pemphigus vulgaris diagnosed by clinical, histologic, and im munofluorescence criteria were selected on the basis of having been treated by one of us (J. C. B.) during most of their illness. Patients' charts wer e reviewed for documentation of laryngeal and nasal symptoms, ear/nose/thro at evaluation, and response to treatment. Results: Twenty-six (49%) of the patients complained of laryngeal or nasal symptoms at some time during the course of their disease. Twenty-one patien ts had laryngeal symptoms and 12 had nasal symptoms. More than 80% of patie nts with laryngeal or nasal symptoms had evidence of pemphigus involvement based on ear/nose/throat examination or rapid response to increased doses o f corticosteroids, and 2 patients had candidiasis confirmed by fungal cultu re. Conclusion: These observations indicate that laryngeal and nasal symptoms a re common in pemphigus vulgaris. In the majority of cases, this appears to be a result of involvement with the disease or with candidiasis.