We present a retrospective analysis of 159 patients with
pemphigus vulgaris and
pemphigus vegetans who were admitted to the Department of Dermatology and Venereology, Zagreb University Hospital Center (Zagreb, Croatia) from 1980 to 1998.
RESULTS: Female to male ratio was approximately 2:1. The mean age was 53 years. During the war years in Croatia (1991-95) we noticed a low incidence of
pemphigus vulgaris, and from 1996 to 1998 the incidence almost doubled. Diagnosis was based on histopathology [showing typical
pemphigus vulgaris changes in 156 (98%) patients], indirect immunofluorescence [positive in 122 (77%) patients], direct immunofluorescence [positive in 141 (89%) patients], and
blister smear cytology (Tzanck test) [positive in 115 (72%) patients]. High dosages of
prednisone (100-150 mg) were given to 129 patients, which was combined with
azathioprine. Patients with refractory
pemphigus vulgaris were treated with intramuscular
gold (14 patients) and
plasmapheresis (five patients). All patients were treated with local
ointments. The prolonged use of high doses of
corticosteroids and
immunosuppressants caused several complications, in particular,
steroid diabetes (37 patients), skin
infections (26 patients), arterial
hypertension (23 patients), cardiorespiratory diseases (22 patients),
sepsis (nine patients), etc. During the hospital treatment, 14 patients died, 10 during 1980-89 and only four during the 1990-98 period. The main causes of death were cardiorespiratory failure (six patients) and
sepsis (five patients).
CONCLUSIONS: