Identification of factors associated with treatment refractoriness of oral lesions in pemphigus vulgaris

Background Oral mucosal lesions of pemphigus vulgaris (PV) are known to show more treatment refractoriness than skin lesions. Objectives To identify the role of different clinical and laboratory parameters in the treatment refractoriness in the oral lesions of PV. Methods This prospective study recruited 50 adult patients of PV having oral lesions. Patients were given treatment appropriate for overall disease severity. Treatment refractoriness was defined arbitrarily as less than 75% reduction in oral objective Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) after treatment for 6 months. Results Of 46 patients who completed the study, 17 (36.96%) were treatment refractory while 29 (63.04%) were treatment responsive. Treatment refractory group had a significantly longer mean duration of disease (p= .02) and mean duration of oral lesions (p= .01), higher percentage of lesions at retromolar trigone (p= .05) and at occlusion line along buccal mucosa (p= .04), higher percentage of deep/crateriform ulcers (p= .00) and erosions with lichenoid hue (p= .00). Herpes simplex virus (HSV) DNA positivity assessed by PCR in oral tissue scraping (p= .02) was also significantly higher in treatment refractory group. No statistically significant differences were observed between the groups in the age, gender distribution, baseline disease severity, involvement of mucosa other than oral cavity, local factors (sharp tooth, poor oral hygiene, etc) and pre- and post-treatment anti-desmoglein 1 & 3 antibody titres. Conclusions Factors observed to be significantly associated with treatment refractoriness of oral lesions were duration of disease/oral lesions, morphology and location of oral lesions and presence of HSV DNA in oral cavity. Any presence of these factors may forewarn the treating physician about a refractory course of oral lesions which would help counselling patients accordingy. This article is protected by copyright. All rights reserved.