Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Original Article
2008:74:4;349-351
doi: 10.4103/0378-6323.42901
PMID: 18797055

Incidence of pemphigus in Thrissur district, south India

Kidangazhiyathmana Ajith Kumar
 Department of Skin and VD, Government Medical College, Thrissur, Kerala, India

Correspondence Address:
Kidangazhiyathmana Ajith Kumar
Department of Skin and VD, Government Medical College, Thrissur-680596
India
How to cite this article:
Kumar KA. Incidence of pemphigus in Thrissur district, south India. Indian J Dermatol Venereol Leprol 2008;74:349-351
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Background: Pemphigus is a common autoimmune blistering disorder in India. However, there are no population based surveys from India available to study the prevalence of this disease. Aims: To estimate the incidence of pemphigus in Thrissur district, Kerala, South India. Methods: Questionnaire based survey was conducted among the practicing dermatologists of Trichur district between 1 st January 2001 and 1 st January 2002 to determine the incidence of pemphigus in the district. Results: Ten cases of pemphigus vulgaris, one case of pemphigus erythematosus, and two cases of pemphigus foliacious were diagnosed during the study period in a population of 2.9 million in Thrissur district. The average age of pemphigus vulgaris patients was 58years in males [42 to 82 years] and 37 in females [25 to 57 years]. The average age of the two male pemphigus foliacious patients was 46 years [52 and 40 years] and the only pemphigus erythematosus patient was a 45 year-old female.Five cases of pemphigus vulgaris were investigated clinically histopathologically and by using direct immunofluorescence, while two were investigated clinically and histopathologically, two cases clinically, and one case clinically and with Tzanck smear. Two cases ofpemphigus foliacious were diagnosed with the aid of direct immunofluorescence and the only case of pemphigus erythematosus was diagnosed with the aid of direct immunofluorescence. Pemphigus vulgaris was common among females. The incidence of pemphigus in Thrissur district is 4.4 per million. Conclusions: This study indicates that the incidence of pemphigus in Thrissur district is high in comparison to the available studies from Germany, France, and the North African country Tunisia.
Keywords: India, Kerala, Pemphigus

Introduction

The Greek word "pemphigus" means a bubble or a blister. Pemphigus consists of a group of epidermal diseases associated with bullae and acantholysis. This group of diseases carries a relatively bad prognosis. Experimental studies in mice have proven that antibodies are directly involved as causes of this disease. [1] Different types of this disease are pemphigus vulgaris (PV), pemphigus foliacious (PF), pemphigus erythematosus (PE), and pemphigus vegetans (P veg). The main difference between PV and PF is the level of epidermal acantholysis. An increased incidence of Fogo selvagem, an endemic form of PF, has been reported in South America and Tunisia. [2] In areas where pemphigus foliaceus and pemphigus vulgaris are not endemic, the cumulative incidence of the two diseases is less than two cases per 100,000 population, and pemphigus vulgaris is usually the more common of the two. In areas where the diseases are endemic, the ratio of the number of cases of pemphigus foliacious to the number of cases of pemphigus vulgaris is nearly 20 to 1. [3] In Brazil, the prevalence of the disorder is 3.4% in regions such as the Amerindian reservation of Limγo Verde and approximately 15,000 patients are known to have pemphigus foliaceus. [3] All these studies suggest that there is a probable environmental factor triggering the disease. There is a general impression among dermatologists that the incidence of pemphigus is comparatively high in the Indian subcontinent. [4] But there has been no systematic study so far to prove or disprove this. This prompted the author to conduct a study to estimate the incidence of pemphigus in the central Thrissur district of the state of Kerala in India.

Methods

The Thrissur Dermatology Club, a scientific forum of all 30 dermatologists practicing in the District, sponsored the study. The study was conducted between 1 st January 2001 and 1 st January2002. An effort was made to make sure that no dermatologist in the district was left out from participating in the study. All dermatologists practicing in the district were requested to fill up a Simple Performa (which includes the details, date, basis of diagnosis etc) and send it to the principal investigator of the study whenever he/she saw a new patient with pemphigus from Thrissur District. Patients from other districts, who came to Thrissur district for treatment or for other reasons, were excluded from the analysis. However, patients who were temporary residents (staying in the district for at least one year) of this district and who happened to develop the disease here were included in the study. Patients who had had lesions during the past years that were diagnosed to be pemphigus for the first time, were also excluded from the analysis.

The details of all patients included in this study are shown in [Table - 1].

Results

In a population of 2.9 million in Thrissur district, [5] ten cases of PV, one case of PE, and two cases of PF were diagnosed during the study period. The average age of PV patients was 58 years in males [42 to 82 years] and 37 years in females [25 to 57 years]. The average age of the two PF patients was 46 years [52 and 40 years]; both the cases were male and the only PE patient was a female aged 45 years. Five cases of PV were diagnosed clinically, histopathologically and by DIF, two cases clinically and histopathologically, two cases of PF were diagnosed by clinical methods and one case with the help of Tzanck smear. Two cases of PF were diagnosed by DIF and biopsy and the only case of PE was diagnosed by DIF. There was only one patient past the age of 80 years, who was diagnosed to have pemphigus vulgaris. PV was more common among females [seven out of ten cases]. This study shows that the incidence of pemphigus in Thrissur district is 4.4 per million and that there is a female predominance [61.5%] in the incidence of pemphigus.

Discussion

This study proves that the incidence of pemphigus in Thrissur district was 4.4 per million in the period of 2001-2002. This incidence is much higher than the incidence rates reported from Germany where 14 cases were reported over an observation period of eight years (1989-1997) among the 1.46 million residents. In Thrissur district, 13 cases were reported over a period of one year (2001-2002) among the 2.9 million residents in the district. The average age of females with PV was 37 years in this study as compared to 50-60 years in the European study. However, female preponderance in the disease was noted in both the studies. The highest incidence of PV among males was in the age group > 55 years, which is almost on par with European studies. [5],[6]

Studies conducted over a period of six years in France and Tunisia showed that the incidence rates in France and Tunisia were 1.6 and 6.7/million/year, respectively, whereas it was 4.4 million/year in our study. The majority of cases reported in Tunisia were of Article for PF and the age group and gender were strongly in contrast to the Indian study reported here. In our study, the reported cases of Article for PF were males of an average age of 46 years and the percentage of Article for PF of the total pemphigus cases was15% as compared to 61% in Tunisia. The age group of pemphigus patients was between 25 and 32 years in Tunisia. [7]

There are studies on the impact of environmental factors on the pathogenesis of pemphigus and their relationship to the incidence of pemphigus in populations. However, we do not have any evidence to propose such hypotheses now due to the preliminary nature of this study. [8]

In a rare disease like pemphigus, a prolonged study involving a larger population may give more precise epidemiological details. However, this study does give us a preliminary idea about the incidence of this rare disease in this geographic area. It is possible that a few patients who migrated out after developing the disease have been missed in this study but that is unlikely to change the incidence of this rare disease.

There are a few clinic-based studies on the prevalence of pemphigus from India. [9] To the best of our knowledge, this is the first study to cover the entire population of a district in India or anywhere in the world to assess the incidence of pemphigus in a population.

Acknowledgement

We acknowledge the support of the members of Trichur Dermatology Club in conducting this study.

References
1.
Anhalt GJ, Labib RS, Voorhees JJ, Beals TF, Diaz LA. Induction of pemphigus in neonatal mice by passive transfer of IgG from patients with the disease. N Engl J Med 1982;306:1189-96.
[Google Scholar]
2.
Robledo MA, Prada S, Jaramillo D, Leon W. South American pemphigus foliaceus: Study of an epidemic in El Bagre and Nechi, Colombia 1982 to 1986. Br J Dermatol 1988;118:737-44.
[Google Scholar]
3.
Edelson RL. Pemphigus-decoding the cellular language of cutaneous autoimmunity. N Engl J Med 2000;343:60-1.
[Google Scholar]
4.
Wilson CL, Wojnarowska F, Dean D, Pasricha JS. IgG subclasses in pemphigus in Indian and UK populations. Clin Exp Dermatol 1993;18:226-30.
[Google Scholar]
5.
Available from: http://www.censusindia.gov.in/Dist_File/datasheet-3207.pdf. Last accessed 23/06/08.
[Google Scholar]
6.
Hahn-Ristick K, Rzany-B, Amagai M, Broker EB, Zillikens D, Increased incidence of Pemphigus vulgaris in southern Europeans living in Germany compared to the native Germans. J Eur Acad Dermatol Venereol 2002;16:68-71.
[Google Scholar]
7.
Bastuji-Garin S, Souissi R, Blum L, Turki H, Nouira R, Jomaa B, et al . Comparative epidemiology of pemphigus in Tunisia and France: unusual incidence of pemphigus foliaceus in young Tunisian women. J Investig Dermatol 1995;104:302-5.
[Google Scholar]
8.
Kanwar AJ, Ajith AC, Narang T. Pemphigus in North India. J Cutan Med Surg 2006;10:21-5.
[Google Scholar]
9.
Brenner S, Tur E, Shapiro J, Ruocco V, D′Avino M, Ruocco E, et al . Pemphigus vulgaris: environmental factors: Occupational, behavioral, medical, and qualitative food frequency questionnaire. Int J Dermatol 2001;40:562-9
[Google Scholar]

Fulltext Views
1,940

PDF downloads
1,040
Show Sections