Value of direct immunofluorescence in predicting remission in pemphigus vulgaris

BACKGROUND: Pemphigus vulgaris is characterized by the presence of autoantibodies to desmogleins. Multiple relapses and remission may occur during the course of the disease. The goal of this study was to determine whether direct immunofluorescence study has any value in detecting immunological remission of pemphigus vulgaris. METHODS: Fifty-seven patients with pemphigus vulgaris who were in clinical remission for at least 3 months, while taking prednisolone 5-7.5 mg/day, were recruited retrospectively for the study. Direct immunofluorescence study had been performed in all patients after a period of at least 3 months in clinical remission. Treatment had been discontinued in all patients with negative results of direct immunofluorescence. RESULTS: Of 57 patients who were in clinical remission, 24 patients (42%) had negative and 33 patients (58%) had positive results of direct immunofluorescence. Eleven patients (46%) with negative results of direct immunofluorescence relapsed within the first year of the follow-up period. Nine patients with negative direct immunofluorescence had a history of more than 6 months of clinical remission before direct immunofluorescence study. Among them, two patients (22%) relapsed. None of four patients with history of more than 12 months of clinical remission before a negative direct immunofluorescence study relapsed. CONCLUSIONS: Negative direct immunofluorescence is an indicator of immunological remission in patients with pemphigus vulgaris after 6-12 months in clinical remission.