Clinical Characteristics and Survival of Pemphigoid and Pemphigus Patients in a Thai Population

Abstract

Objective: Pemphigoid and pemphigus are skin diseases with high morbidity and mortality. The research aims to study the clinical presentations, comorbidities, and medications used prior to diagnosis, as well as the survival rates and prognostic factors for pemphigoid and pemphigus patients. Materials and Methods: The cohort study was conducted on retrospective data of patients who were treated at Naresuan University Hospital between 1 October 2012 and 30 September 2022. Results: There were 30 pemphigoid patients and 44 pemphigus patients. Pemphigoid patients were on average older than pemphigus patients (76 years vs 52 years), have more skin blisters, and less oral cavity lesions. Neurological disease increases risk of being diagnosed as a bullous pemphigoid (odds ratio=4.6, p-value =0.051). After adjustment by neurologic disease and age at diagnosis, pemphigoid was not significantly associated with the use of any medications. The survival rate of pemphigus was 91.1% at 1 year and 82.2% at 5 years, while the survival rate of pemphigoid was 69.9% at 1 year, and 47.7% at 5 years. In multivariable Cox regression analysis, there was worse prognosis among pemphigoid and pemphigus patients that have comorbidity disease (adjusted HR= 3.13, p-value=0.057) and were older than 70 years (adj HR= 6.93, p-value=0.015). Conclusion: Clinical characteristics of bullous pemphigoid and pemphigus were different such as age of onset, presence of blister and oral lesion. Neurological disease was a risk factor for developing bullous pemphigoid than pemphigus. Survival of pemphigoid patients was worse than pemphigus patients. However, this finding could be confounded by older age of pemphigoid patients.