Think globally, act locally: Expert opinions from Asia on the diagnosis and treatment of pemphigus vulgaris

Background : Pemphigus vulgaris (PV) is the most common blistering disease in Iran and many other Asian countries with a relatively high incidence and involvement of both skin and mucous membranes in majority of the patients.
Aims: To assess the opinions of Asian experts on the diagnosis and management of PV.
Settings and design: It was a questionnaire-based mailed/e-mailed survey.
Materials and Methods: The questionnaire was sent to 29 dermatologists from different countries of Asia who treat autoimmune blistering disorders, with at least 5 years′ experience in this field, and who visit at least five new PV patients annually. Questions included duration of experience, number of patients treated and diagnostic and treatment approaches for PV.
Statistical analysis used: Percentage prevalence; some data are reported as mean ± SD.
Results: All of the 29 physicians participated in the survey; among them, 79.3% visit their patients within 6 months after the onset of symptoms. Diagnosis of PV is confirmed by histologic and direct immunofluorescence examinations by 65.5% of physicians. All of them initiate the treatment with corticosteroids (48.3% with a dose of at least 2 mg/kg/day prednisolone), and 89.7% add adjuvant immunosuppressors at the same time. Of the adjuvant agents used, azathioprine is used by 82.8% of physicians.
Conclusions: Different trends in diagnostic techniques and treatment options for PV among the experienced authorities emphasize the urgent need for large-scale controlled trials in order to reach consensus standards in this field. In addition, regional and worldwide consensus meetings to consider all regional and genetic similarities and differences are highly recommended.