News Forum: Establishing the extent of pemphigus vulgaris

GPs with an interest in dermatology review the latest papers of significance from research teams across the world

Espana A, Fernandez S, del Olmo J et al. Br J Dermatol 2007;156(4):733-7

This interesting study looked at pemphigus vulgaris (PV), the autoimmune condition characterised by mucocutaneous intra-epithelial blisters, and the involvement of the ear, nose and throat in the disease process.

The authors highlight the two types of PV - mucosal PV and mucocutaneous PV. They performed a prospective study of all patients diagnosed with PV, of both types, who were treated in the department of dermatology at the University of Navarra between 2001 and 2005.

This involved 16 patients in total, 10 cases of mucosal PV and six of mucocutaneous PV. All of the patients were investigated endoscopically to establish ear, nose and throat involvement.

Of the 16 patients, 94 per cent had oral symptoms and active oral PV lesions clinically. Throat symptoms presented in 81 per cent of patients, but endoscopic investigation found active PV lesions in 88 per cent (50 per cent with lesions on pharyngeal and laryngeal mucosa, 25 per cent with lesions on laryngeal mucosa only and 12.5 per cent with lesions on pharyngeal mucosa only).

Laryngeal mucosal involvement was seen more commonly in those patients with mucosal PV. Nasal symptoms were present in just 38 per cent of patients; however, endoscopically, 62 per cent of patients had active PV lesions of the nasal mucosa.

The findings of this study demonstrate that the use of endoscopy of the ear, nose and throat in patients with PV allows for a more extensive examination of the mucosa and establishes a more accurate clinical picture of the extent of the disease.

The authors conclude that 'a more accurate diagnosis can then be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved'.

This paper highlights the importance of considering the use of endoscopic investigation of the ear, nose and throat as routine in those patients found to have PV.

- Dr Jane Barnard, GP with an interest in dermatology in Yateley, Hampshire

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