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Claire Abasq, MD; Hugo Mouquet, PhD; Danièle Gilbert, PhD; François Tron, MD, PhD; Vanessa Grassi, PhD; Philippe Musette, MD, PhD; Pascal Joly, MD, PhD

Arch Dermatol. 2009;145(5):529-535.

Objective  To assess the predictive value of anti–desmoglein (Dsg) 1 and anti-Dsg3 antibody (Ab) enzyme-linked immunosorbent assay (ELISA) values for the occurrence of relapses in pemphigus.

Design  Retrospective study.

Setting  Dermatology departments from 13 university hospitals in France.

Patients  The study population comprised 26 patients with typical clinical, histologic, and immunofluorescence findings of pemphigus, who were followed up over a 17-month period.

Main Outcome Measures  Serial anti-Dsg1 and anti-Dsg3 Ab ELISA values were recorded during the patients' follow-up examinations and correlated with the occurrence of skin and/or mucosal relapses.

Results  A significant reduction of anti-Dsg1 (P < .001) and anti-Dsg3 (P < .001) Ab ELISA values was observed in serum samples from patients with pemphigus foliaceus or pemphigus vulgaris after the initial treatment. During the long-term follow-up, anti-Dsg1 Ab ELISA values correlated with the course of skin lesions (P = .03); the 20 U/mL cutoff for the anti-Dsg1 Ab ELISA value provided a 79% positive and an 84% negative predictive value for the occurrence of cutaneous relapses. No correlation was observed between anti-Dsg3 Ab ELISA values and the course of mucosal lesions (P = .13). Anti-Dsg3 Ab ELISA values higher than the 14-U/mL cutoff were observed in 5 of the 5 patients with relapse and in 10 of the 13 patients with ongoing mucosal remission, providing a 100% sensitivity but a poor specificity of 23%. A cutoff value of 130 U/mL for anti-Dsg3 Abs was calculated based on the receiver operating characteristics curve and provided an 84% positive and an 81% negative predictive value.

Conclusions  Anti-Dsg1 Ab ELISA values are more closely correlated than anti-Dsg3 Ab ELISA values with the course of the disease in patients with pemphigus vulgaris or pemphigus foliaceus. This should be taken into account for the management of patients with pemphigus.

Author Affiliations: Department of Dermatology (Drs Abasq, Musette, and Joly), Inserm Unit 905 (Drs Mouquet, Gilbert, Tron, Musette, and Joly), and Department of Biostatistics (Dr Grassi), Rouen University Hospital, Rouen, France.

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