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What is Pemphigus? A Personal Perspective by agmoore2

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What is Pemphigus? A Personal Perspective
<center><a href="https://commons.wikimedia.org/wiki/File:Changthangi_Goats_in_Jammu_and_Kashmir.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmbJ4sxi3NETTc1zSJydHgKC3ihJAdUiC2MaUhpe5PUzhr/Cashmere%20goat%20Changthangi_Goats_in_Jammu_and_Kashmir%20%20Eatcha%204.0.jpg" alt="Cashmere goat Changthangi_Goats_in_Jammu_and_Kashmir  Eatcha 4.0.jpg"></a></center><br>
<center><em><a href="https://www.frontiersin.org/articles/10.3389/fgene.2018.00553/full" rel="noopener" title="This link will take you away from steemit.com">Goats in Tibet are susceptible to pemphigus.</a></em></center>
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<p>About twenty years ago I showed my doctor a spot behind my left ear. 
 The doctor referred me to a dermatologist who performed a biopsy.  The 
report came back: pemphigus vulgaris.  I looked that up on the Internet 
and refused to accept the idea, so I went to a research hospital.  
Second biopsy: pemphigus vulgaris.</p>
<p>A powerful topical steroid erased the spot quickly and it never came 
back.  As you read this blog you will see that my fortune was good in 
the extreme.  Pemphigus can run a cruel course, and it can take a life. 
 Many, many people who receive the same pathology report I did, do not 
share my good fortune.</p>
<p>Here's some of what I learned about pemphigus in the ensuing years.  
The information might be useful someday, for you, your family or your 
pet. Pemphigus <a href="http://www.pemphigus.org/companion-animals-too-can-get-pemphigus-2/" rel="noopener" title="This link will take you away from steemit.com">affects animals, too.</a></p>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Akita-j.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmT3XZDvNkt83KCDUhAGRLEPFACQgtNR1noyQHVep2eAVp/Akita%20Jonnydrh%20public.jpg" alt="Akita Jonnydrh public.jpg"></a></center>   <br>
<em>Certain dog breeds are more susceptible to pemphigus than others.  These breeds include <a href="https://vcahospitals.com/know-your-pet/pemphigus-in-dogs" rel="noopener" title="This link will take you away from steemit.com">Akita, Chow Chow, and Cocker Spaniels.</a></em>
<hr>
<hr>
<hr>
<h4><center>What is It?</center></h4>
<hr>
<p>According to <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">Merk Manual</a>:<br>
"Pemphigus vulgaris is an uncommon, potentially fatal, autoimmune 
disorder characterized by intraepidermal blisters and extensive erosions
 on apparently healthy skin and mucous membranes". <sup><a href="https://steemit.com/submit.html#footnote1" rel="noopener" title="This link will take you away from steemit.com">1</a></sup></p>
<p>Translated into ordinary language: pemphigus is very rare, and it can
 be fatal.  Blisters form within the cells of the upper layer of skin.  
With a particular type of pemphigus, pemphigus vulgaris, blisters also 
form in the mucous membranes.</p>
<hr>
<p>Pemphigus is categorized as an <a href="https://www.fda.gov/drugs/drug-information-consumers/orphan-products-hope-people-rare-diseases" rel="noopener" title="This link will take you away from steemit.com">orphan disease</a>
 by the U.S. Food and Drug Administration. The occurrence of pemphigus 
varies by region across the globe, and also by ethnicity. It ranges 
between <a href="https://rarediseases.org/rare-diseases/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">0.7 and 5</a>
 people, per million. Populations with a Mediterranean or Ashkenazi 
Jewish background are at higher risk. The incidence in these populations
 may be as high as <a href="http://www.pemphigus.org/research/clinically-speaking/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">6-32 cases per million.</a>  A particular subset of pemphigus (endemic pemphigus) occurs with greater frequency in the <a href="http://www.pemphigus.org/research/clinically-speaking/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">Brazilian rainforest and in Colombia.</a></p>
<p>There are photos available on the Internet, of people afflicted with 
pemphigus.  I'd feel I was violating those people if I used such 
distressing, personal photos.  However I did find an illustration that 
is less intrusive and yet reflects how extensively pemphigus can affect 
the skin.  This picture shows a patient (in 1896) with pemphigus 
foliaceus, PF,  a less fatal type of the disease than pemphigus 
vulgaris, PV.</p>
<p>The severe condition of this patient is one that was suffered by most before the introduction of modern treatments.</p>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Plate_XVIII,_Pemphigus_foliaceus,_Crocker_1896_Wellcome_L0074328.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmNU5JTLa9WoVA1xushnTgbMAwdC7F2iUprfmNq2s6uku6/Pemphigus%20foliaceus,%20Crocker2%201896%20Wellcome%20L0074328%20CC%204.0%20Wellcome%20Trust.jpg" alt="Pemphigus foliaceus, Crocker2 1896 Wellcome L0074328 CC 4.0 Wellcome Trust.jpg">  </a></center>
<hr>
<hr>
<h4><center>Types of Pemphigus</center></h4>
<hr>
<p>As I poured through the literature, the words pemphigus and 
pemphigoid appeared in different contexts.  A variety of blistering 
diseases can be characterized by the words pemphigus or pemphigoid.  I 
found some categorical clarity in a 2016 article, <em>Mechanisms of Disease: Pemphigus and Bullous Pemphigoid</em>, published in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560122/" rel="noopener" title="This link will take you away from steemit.com"><em>Annual Review of Pathology</em></a>.
  The authors separate the histological character (tissue analysis, 
available from a biopsy) of the disease from its clinical manifestations
 (what does it look like, what are the symptoms).</p>
<p>According to this article (and also according to the <a href="http://www.pemphigus.org/research/clinically-speaking/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">International Pemphigus and Pemphigoid Foundation</a>),
 histologically there are two types: pemphigus vulgaris--PV-- and 
pemphigus foliaceus--PF .  In tissue samples of both types there will be
 evidence of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703183/" rel="noopener" title="This link will take you away from steemit.com">autoantibodies.</a>.
 It is the type of autoantibody and its specific target tissue that 
become diagnostic in pemphigus.  A pathologist assesses this in a 
biopsy.</p>
<p>In pemphigus, autoantibodies target a specific substance found in the
 epidermis: desmoglein.   With the destruction of desmoglein, essential 
cells, called keratinocytes, cannot hold together.  Blisters form in 
those areas of failure and the skin essentially falls apart.</p>
<hr>
<h5><center>Keratinocytes</center></h5>
<center><a href="https://commons.wikimedia.org/wiki/File:Human_keratinocytes.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmY6yKt3P8tNZE6HUrdJRiA5cFbKudA3gQGodSkjjx5bzY/Human%20keratinocytes3%20ManatYesbol,%20Zhansaia,%20Gaziza%20Aiatbekovna%204.0.jpg" alt="Human keratinocytes3 ManatYesbol, Zhansaia, Gaziza Aiatbekovna 4.0.jpg"></a></center>
<hr>
<hr>
<p><em>Keratinocytes make up about <a href="http://library.open.oregonstate.edu/aandp/chapter/5-1-layers-of-the-skin/" rel="noopener" title="This link will take you away from steemit.com">95% of the epidermis.</a>  Without treatment, a pemphigus patient may actually lose most of the epidermis.  This would lead to <a href="https://rarediseases.org/rare-diseases/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">fluid loss, widespread infection, and likely sepsis.  Most patients would  die in about two years.</a></em></p>
<hr>
<p>There are different types of desmoglein.  A diagnosis of PV or PF is based on which kind of <a href="http://www.jofs.in/article.asp?issn=0975-8844;year=2014;volume=6;issue=2;spage=104;epage=107;aulast=Gandhi" rel="noopener" title="This link will take you away from steemit.com">desmoglein is under attack.</a>
  A biopsy will reveal this. If it turns out that desmoglein 1 is the 
target, then the finding is for PF.  If desmoglein 3 is under attack, 
then the diagnosis is PV.  There are other diagnostic tests that are 
used to come up with a definitive diagnosis, but separating the 
histology into attacks on desmoglein 1 and 3 is a basic step.</p>
<hr>
<h5><center>IgG, an Autoantibody Found in Pemphigus</center></h5>
<center><a href="https://upload.wikimedia.org/wikipedia/commons/2/27/Anatomy_of_an_IgG.png" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmUcqFiSCSEMwUVoojE15Z9yyy6FLrU8WRXUFtGmEPUceZ/IgG%20Anatomy%20wikipedia%20user%20AJVincelli%20public%20domain.jpg" alt="IgG Anatomy wikipedia user AJVincelli public domain.jpg"></a></center>
<hr>
<hr>
<p><em>The presence of <a href="https://www.ncbi.nlm.nih.gov/pubmed/19963079" rel="noopener" title="This link will take you away from steemit.com">IgG autoantibodies is a hallmark</a> of PF and PV.</em></p>
<p><em>IgG is an immunoglobulin.  It is the <a href="https://www.sciencedirect.com/topics/neuroscience/immunoglobulin-g" rel="noopener" title="This link will take you away from steemit.com">most abundant</a>
 immunoglobulin in the body and is necessary for proper function of the 
immune system.  As a matter of fact, it is the only antibody class that 
can <a href="http://www.jimmunol.org/content/jimmunol/194/1/13.full.pdf" rel="noopener" title="This link will take you away from steemit.com">cross the placental barrier.</a> This allows the mother to bestow some of her immunity on the fetus.</em></p>
<p><em>IgG is not the only autoantibody involved in the development of 
pemphigus, but it is the most predominant.  It is also implicated in a 
number of other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602543/" rel="noopener" title="This link will take you away from steemit.com">autoimmune diseases.</a></em></p>
<hr>
<hr>
<h5><center>Desmoglein 1 and Desmoglein 3</center></h5>
<hr>
<p>Most of us know that keratin is contained in hair, nails and skin. Keratinocytes <a href="http://library.open.oregonstate.edu/aandp/chapter/5-1-layers-of-the-skin/" rel="noopener" title="This link will take you away from steemit.com">manufacture and store keratin, </a> and are the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28223740" rel="noopener" title="This link will take you away from steemit.com">basic building blocks</a>
 of the epidermis.  Keratinocytes are held together by extracellular 
structures called desmosomes. These structures are like the mortar 
between bricks in a wall.  Desmosomes are comprised of two 
glycoproteins, <a href="http://jcs.biologists.org/content/127/10/e1001" rel="noopener" title="This link will take you away from steemit.com">desmoglein and desmocollin.</a></p>
<p>Remember, in PF and PV, it is desmoglein that is destroyed by 
autoantibodies.  So, if the desmoglein is  destroyed, desmosome, the 
intracellular mortar between keratinocytesis is destroyed.  The 
keratinocytes are no longer held together.   The basic building blocks 
of the skin separate, and the skin literally falls apart.  Blisters form
 in the gaps that open up.</p>
<hr>
<hr>
<hr>
<p><em>I made a GIF to demonstrate how the structure of the skin is 
undermined by the destruction of desmoglein.  Here the mortar between 
the bricks in a wall slowly erodes and the bricks fall away.  Compare 
this GIF to the image of tissue undergoing the process of acantholysis, a
 little further down in the blog.</em></p>
<hr>
<center><img src="https://steemitimages.com/0x0/https://cdn.steemitimages.com/DQmP116hVwdgm8PyhqPYoPB5C9iTrVcPt8m1AXi3GoUFWpA/brick%20wall%204.gif" alt="brick wall 4.gif"></center>
<center><em>Brick wall from Paint 3D</em></center>
<hr>
<hr>
<hr>
<hr>
<hr>
<h5><center>Illustration of Desmosome Cell Adhesion</center></h5>
<center><a href="https://commons.wikimedia.org/wiki/File:Desmosome_cell_junction_en.svg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmQq8iie1g2rRuN5xfzDKHSr5KMR9ooAwLXqRnYDugQQi9/Desmosome2.jpg" alt="Desmosome2.jpg"></a></center>
<hr>
<p>Desmosomes are only one type of intracellular juncture in animal 
tissue.  Most of us are more familiar with another kind: cartilage.  
Both desmosomes and cartilage are designed to bear weight and to allow 
for flexibility.   You can see in the illustration above that fibers 
connect one cell to another at an adhesion point called a cadherin.  It 
is the cadherin that is <a href="http://jcs.biologists.org/content/127/10/e1001" rel="noopener" title="This link will take you away from steemit.com">is made up of desmoglein.</a>  This is precisely the area of vulnerability in pemphigus.</p>
<hr>
<p>Below is a microscopic image of tissue taken from a patient who has 
PV.  Even with the untrained eye, we can see gaps in the tissue. 
According to the description that appears under this photo, "an early 
intraepidermal vesicle" is evident in this tissue.<sup><a href="https://steemit.com/submit.html#footnote2" rel="noopener" title="This link will take you away from steemit.com">2</a></sup>  That is, blisters are already forming, and are evident.  Compare this gap to the gap in my brick wall GIF.</p>
<p>The process by which desmosomes are destroyed and epithelial tissue separates is called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/acantholysis" rel="noopener" title="This link will take you away from steemit.com">acantholysis.</a></p>
<center><a href="https://commons.wikimedia.org/wiki/File:Pemphigus_immunofluorescence.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmZxm7ytyKYfRFZfuqHXQ8xNQm5ESm6j1HZ1PF69eycvtx/Pemphigus_immunofluorescence2%20%20attr%20Emmanuelm%20at%20english%20wikipedia%203.0.jpg" alt="Pemphigus_immunofluorescence2  attr Emmanuelm at english wikipedia 3.0.jpg"></a></center>
<hr>
<hr>
<h5><center>A Personal Digression</center></h5>
<hr>
<p>In the title of this blog I refer to a personal perspective. Here it 
is: my experience does not resemble in any way what I have just 
described.  Despite the diagnosis of pemphigus vulgaris, based on two 
biopsies, a blister never formed. Both pathologists did find that IgG 
autoantibodies were attacking desmoglein 3 in the biopsied tissue.  By 
the time I showed my doctor the spot, almost two years had passed (!).</p>
<p>The spot had grown a bit, but it was still under 2 cm.  I thought I might have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872290/" rel="noopener" title="This link will take you away from steemit.com">modest squamous cell carcinoma.</a></p>
<p>I was wrong.</p>
<hr>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Diagram_of_human_skin.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmXAT83RojGA2ZwygXt7k66GnwiuQEUjKE1RRCEHU8xHc9/Skin2%20Diagram%20of%20human%20skin%20Crystal%20Mason%203.0.jpg" alt="Skin2 Diagram of human skin Crystal Mason 3.0.jpg"></a></center>
<p><em>I selected this diagram out of many because it indicates that squamous cells are near the surface of the skin.  <a href="https://opentextbc.ca/anatomyandphysiology/chapter/5-1-layers-of-the-skin/" rel="noopener" title="This link will take you away from steemit.com">Stratified squamous epithelium</a>
 comprise the epidermis.  It is here, in the squamous cells, that 
pemphigus (PV and PF) develops. These cells are flat (wider than they 
are high) and are arranged in layers.</em></p>
<hr>
<hr>
<p>The image below shows the lining of a normal esophagus.  Stratified 
squamous cells are visible.  The esophagus is lined with a mucous 
membrane, which means it is vulnerable to the development of PV, but not
 PF.</p>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Tinci%C3%B3n_hematoxilina-eosina.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmSB31261uWkaVPD1v7zCBLA5sgJ9pgcKVDSzvQbjXGLrN/squamous2%20cells%20in%20the%20esophagus,normal%20stain%20Samir@enwiki%203.0.jpg" alt="squamous2 cells in the esophagus,normal stain Samir@enwiki 3.0.jpg"></a></center>
<hr>
<hr>
<p>In PV,  mucous membranes are often the first sites affected.  Typically, oral lesions appear.  Because of this, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505431/" rel="noopener" title="This link will take you away from steemit.com">dentists can play an important role</a>
 in detecting the disease. Mucosal involvement may extend to the 
esophagus, the nose and even inside the eyelids. (Both pemphigus 
vulgaris and pemphigus foliaceus <a href="http://www.pemphigus.org/when-the-eyes-have-it-2/" rel="noopener" title="This link will take you away from steemit.com">may effect the eyelids.</a>)</p>
<p>Before the advent of modern treatment, oral and esophageal lesions inhibited eating, and this contributed to mortality.</p>
<hr>
<hr>
<h3><center>Clinical Manifestations of Pemphigus</center></h3>
<p>While pemphigus is broadly described as being either pemphigus 
foliaceus or pemphigus vulgaris, based on histology, there are 
subdivisions of these two types. It's hard to get different sources to 
agree on what these subdivisions are, so I settled for the grouping 
offered by <a href="https://rarediseases.org/rare-diseases/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">NORD, National Organization for Rare Diseases.</a> Please note, these subdivisions may overlap, or appear sequentially.</p>
<hr>
<p>NORD lists six subdivisions, two of these have already been discussed in some detail:</p>
<h6>Pemphigus Foliaceus</h6>
<h6>Pemphigus Vulgaris</h6>
<hr>
<p>I'll say a few words about the other four subcategories:</p>
<hr>
<hr>
<h5><center><strong>Endemic Pemphigus</strong></center></h5>
<p>I referred to this earlier in the blog as occurring in the 
rainforests of Brazil and Colombia. I have also read an article which 
relates <a href="http://www.scielo.br/scielo.php?script=sci_arttext&amp;pid=S0365-05962012000600003" rel="noopener" title="This link will take you away from steemit.com">similar cases in Peru</a>
  to the same type of endemic disease.  The suspicion has always existed
 that an environmental factor triggers the disease in genetically 
susceptible individuals.  A fascinating  2016 article in the <a href="http://www.jimmunol.org/content/196/5/2041" rel="noopener" title="This link will take you away from steemit.com"><em>Journal of Immunology</em></a> suggests that the environmental exposure might be the bite of a sandfly.  In this case, pathogenic IgG4, instead of IgG1 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816565/" rel="noopener" title="This link will take you away from steemit.com">(which is often the culprit)</a> is implicated.</p>
<hr>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Lutzomyia_longipalpis-sandfly.jpg" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmek1ZdDxGMd113k7GkHf16e7uyJQQNjrFWbZPSeDihDAN/Lutzomyia%20longipalpis-sandfly2%20Ray%20Wilson,%20Liverpool%20School%20of%20Tropical%20Medicine%202.5%20and%20PLOS%20One%204.0.jpg" alt="Lutzomyia longipalpis-sandfly2 Ray Wilson, Liverpool School of Tropical Medicine 2.5 and PLOS One 4.0.jpg"></a></center>
<p><em>Sandflies are found all over the world, but this variety is only 
found in the so-called 'New World'--which would encompass Brazil, Peru 
and Colombia, the countries where endemic pemphigus has been identified</em>.</p>
<hr>
<hr>
<h5><center><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539423/" rel="noopener" title="This link will take you away from steemit.com"><strong>Pemphigus Erythematosus (Senear-Usher syndrome)</strong></a></center></h5>
<p>This may be an overlap disease with lupus erythematosus.  Patients 
have serology that is positive for lupus (ex: anti-SM and 
double-stranded DNA antigens, hallmarks of  lupus) and also have 
histology and clinical presentation compatible with pemphigus.</p>
<hr>
<hr>
<h5><center><strong>Pemphigus Vegetans</strong></center></h5>
<p>This is described by most sources as a rare, localized, benign form of PV.  Partly because of its rarity, it can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505428/" rel="noopener" title="This link will take you away from steemit.com">difficult to diagnose.</a></p>
<hr>
<hr>
<h5><center><strong>Drug-Induced Pemphigus</strong></center></h5>
<hr>
<center><a href="https://commons.wikimedia.org/wiki/File:Mercapto_Group_General_Formulae.png" rel="noopener" title="This link will take you away from steemit.com"><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmac6SwXctrmGLoxyPa6QNuUoLTFxUPj84rpYzkMYnucTP/Thiol%20Group%20J%C3%BC%20public2.jpg" alt="Thiol Group Jรผ public2.jpg"></a></center>
<p><em>The  -SH in the formula above is a sulfhydryl, and it is this 
that characterizes the thiol group of drugs. This group of drugs is 
implicated in the <a href="https://www.ncbi.nlm.nih.gov/books/NBK499864/" rel="noopener" title="This link will take you away from steemit.com">development of pemphigus.</a></em></p>
<hr>
<p>This is probably one of the most important parts of my blog today:  
pemphigus may be caused by drugs that are commonly prescribed.  In many 
cases, the disease will clear up when the drug is withdrawn, but this is
 not always the case.  Also, pemphigus may not develop until months 
after the <a href="https://www.dermnetnz.org/topics/drug-induced-pemphigus/" rel="noopener" title="This link will take you away from steemit.com">drug has been commenced,</a> so it's hard to draw a relationship between the drug and the disease.    According to <a href="https://www.ncbi.nlm.nih.gov/books/NBK499864/" rel="noopener" title="This link will take you away from steemit.com">StatPearls,</a> drugs are actually the most likely cause of pemphigus, especially pemphigus foliaceus.</p>
<p>Certain classes of drugs are more closely associated with the disease
 than others.  Thiols (especially d-penicillamine) have been implicated.
    Phenols have also been implicated.  Interestingly,  diet can also be
 a source of phenols and thiols, so foods that contain these...chives, 
garlic, onion, black pepper, cashew and mangoes...should be avoided by 
anyone who has been diagnosed with pemphigus.</p>
<p>According to <a href="https://www.dermnetnz.org/topics/drug-induced-pemphigus/" rel="noopener" title="This link will take you away from steemit.com">DermNet NZ</a>,
 about 50% of the cases caused by thiols will clear up when the drug is 
withdrawn.  Disease caused by non-thiol drugs, "have a better 
prognosis".<sup><a href="https://steemit.com/submit.html#footnote3" rel="noopener" title="This link will take you away from steemit.com">3</a></sup></p>
<p><a href="http://www.ijdvl.com/article.asp?issn=0378-6323;year=2018;volume=84;issue=2;spage=137;epage=147;aulast=Ranugha" rel="noopener" title="This link will take you away from steemit.com">Anti-hypertensives</a> and <a href="https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">NSAIDs have also been implicated.</a></p>
<hr>
<hr>
<h2><center>Treatments</center></h2>
<p>The cornerstone of treatment remains corticosteroids, administered 
systemically, topically or a combination of the two.  These drugs can 
have serious side effects, including:  cataracts, diabetes, 
osteoporosis, psychosis, chronic migraine and increased susceptibility 
to infection.  The effects have been found to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746020/" rel="noopener" title="This link will take you away from steemit.com">dose dependent.</a>  The goal, for physician and patient, is to take the lowest effective dose. This treatment strategy is referred to as <a href="https://www.valueinhealthjournal.com/article/S1098-3015(14)00294-0/fulltext" rel="noopener" title="This link will take you away from steemit.com">'steroid sparing',</a> and it often involves a balancing act between drug efficacy and drug effects.</p>
<hr>
<p>Some other treatments for pemphigus are:<br>
<a href="http://www.pemphigus.org/azathioprine-in-the-treatment-of-autoimmune-blistering-diseases/" rel="noopener" title="This link will take you away from steemit.com">Azathioprine</a><br>
<a href="http://www.e-ijd.org/article.asp?issn=0019-5154;year=2016;volume=61;issue=4;spage=418;epage=426;aulast=Sardana" rel="noopener" title="This link will take you away from steemit.com">Cyclophosphamide</a><br>
<a href="https://www.uptodate.com/contents/initial-management-of-pemphigus-vulgaris-and-pemphigus-foliaceus/abstract/5" rel="noopener" title="This link will take you away from steemit.com">Mycophenalate</a><br>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/23772610" rel="noopener" title="This link will take you away from steemit.com">Methotrexate</a><br>
<a href="https://www.gene.com/media/press-releases/14727/2018-06-07/fda-approves-genentechs-rituxan-rituxima" rel="noopener" title="This link will take you away from steemit.com">Rituximab</a><br>
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540507/" rel="noopener" title="This link will take you away from steemit.com">Dapsone</a><br>
<a href="https://jamanetwork.com/journals/jamadermatology/article-abstract/420177" rel="noopener" title="This link will take you away from steemit.com">IV infusion of immunoglobulin</a><br>
<a href="https://www.mdedge.com/dermatology/article/97747/wounds/plasmapheresis-refractory-pemphigus-vulgaris-revisiting-old" rel="noopener" title="This link will take you away from steemit.com">Plasmapheresis</a></p>
<hr>
<h4><center>Causes/Antagonists</center></h4>
<p>We've already covered drugs and diet.  Genetics seems to play a weak 
role, particularly in some families. According to GARD, Genetic and Rare
 Diseases Information Center, <a href="https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">"
 Predisposition...is linked to genetic factors...histocompatibility 
complex (MHC) class II molecules, in particular alleles of human 
leukocyte antigen (HLA) DR4, appear to increase susceptibility to 
pemphigus vulgaris."</a></p>
<p>There are known environmental antagonists, besides drugs, diet and, possibly, sandflies.  One of these, very avoidable, <a href="http://www.pemphigus.org/tag/sun-exposure/" rel="noopener" title="This link will take you away from steemit.com">is the sun..</a>or any form of <a href="https://www.ncbi.nlm.nih.gov/books/NBK431072/" rel="noopener" title="This link will take you away from steemit.com">UV radiation.</a></p>
<hr>
<h5><center>Ending on a Personal Note</center></h5>
<p>I have a serious UV allergy, which encompasses not only sun but 
indoor sources of UV.  This may be one of the factors that has kept 
pemphigus at bay all these years.  I avoid the sun.  My wardrobe offers 
evidence of that.  I have a closet full of hats.  So I decided to end 
the blog on a rather humorous note:  a GIF that shows just <em>some</em> of my hats :)</p>
<center>A Few of My Hats</center><br>
<center><img src="https://steemitimages.com/0x0/https://cdn.steemitimages.com/DQmdmiagTW48VKUEBvzYhoSzcB18zKzWXYQfbN2ym6wWopw/hat%20blend2.gif" alt="hat blend2.gif"></center>
<hr>
<p>Anyone who wants to use any of my GIFs, for any reason, may do so without restriction.</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmTDqHVniPuLrhgLZxBCzjKQYcdiCXVL6Vp6qnRSHYWKe2/accent%20accent.jpg" alt="accent accent.jpg"></center>
<h4><center>Footnotes</center></h4>
<p><sup><a href="https://steemit.com/submit.html#footnote1" rel="noopener" title="This link will take you away from steemit.com">1</a></sup>Merck Manual Professional Version: <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com"><em>Pemphigus Vulgaris</em></a></p>
<p><sup><a href="https://steemit.com/submit.html#footnote2" rel="noopener" title="This link will take you away from steemit.com">2</a></sup><a href="https://commons.wikimedia.org/wiki/File:Pemphigus_immunofluorescence.jpg" rel="noopener" title="This link will take you away from steemit.com">Pemphigus immunofluorescence</a></p>
<p><sup><a href="https://steemit.com/submit.html#footnote3" rel="noopener" title="This link will take you away from steemit.com">3</a></sup>DermNet <a href="https://www.dermnetnz.org/topics/drug-induced-pemphigus/" rel="noopener" title="This link will take you away from steemit.com"><em>Drug-induced pemphigus</em></a></p>
<hr>
<hr>
<h4><center>Some Sources Used in Writing This Blog</center></h4>
<ol><li><p>Sequence Characterization of DSG3 Gene to Know Its Role in High-Altitude Hypoxia Adaptation in the Chinese Cashmere Goat  <a href="https://www.frontiersin.org/articles/10.3389/fgene.2018.00553/full" rel="noopener" title="This link will take you away from steemit.com">https://www.frontiersin.org/articles/10.3389/fgene.2018.00553/full</a></p></li><li><p>Companion Animals, Too, Can Get Pemphigus  <a href="http://www.pemphigus.org/companion-animals-too-can-get-pemphigus-2/" rel="noopener" title="This link will take you away from steemit.com">http://www.pemphigus.org/companion-animals-too-can-get-pemphigus-2/</a></p></li><li><p>Pemphigus in Dogs  <a href="https://vcahospitals.com/know-your-pet/pemphigus-in-dogs" rel="noopener" title="This link will take you away from steemit.com">https://vcahospitals.com/know-your-pet/pemphigus-in-dogs</a></p></li><li><p>Pemphigus Vulgaris  <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">https://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/pemphigus-vulgaris</a></p></li><li><p>Orphan Products: Hope for People With Rare Diseases  <a href="https://www.fda.gov/drugs/drug-information-consumers/orphan-products-hope-people-rare-diseases" rel="noopener" title="This link will take you away from steemit.com">https://www.fda.gov/drugs/drug-information-consumers/orphan-products-hope-people-rare-diseases</a></p></li><li><p>Pemphigus   <a href="https://rarediseases.org/rare-diseases/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">https://rarediseases.org/rare-diseases/pemphigus/</a></p></li><li><p>Pemphigus  <a href="http://www.pemphigus.org/research/clinically-speaking/pemphigus/" rel="noopener" title="This link will take you away from steemit.com">http://www.pemphigus.org/research/clinically-speaking/pemphigus/</a></p></li><li><p>Mechanisms of Disease: Pemphigus and Bullous Pemphigoid <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560122/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560122/</a></p></li><li><p>Nature and functions of autoantibodies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703183/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703183/</a></p></li><li><p>Layers of the Skin <a href="http://library.open.oregonstate.edu/aandp/chapter/5-1-layers-of-the-skin/" rel="noopener" title="This link will take you away from steemit.com">http://library.open.oregonstate.edu/aandp/chapter/5-1-layers-of-the-skin/</a></p></li><li><p>Usefulness of desmoglein 1 and 3 in serodiagnosis of pemphigus 
vulgaris and its correlation with disease activity - ELISA study  <a href="http://www.jofs.in/article.asp?issn=0975-8844;year=2014;volume=6;issue=2;spage=104;epage=107;aulast=Gandhi" rel="noopener" title="This link will take you away from steemit.com">http://www.jofs.in/article.asp?issn=0975-8844;year=2014;volume=6;issue=2;spage=104;epage=107;aulast=Gandhi</a></p></li><li><p>Definition of human autoimmunity--autoantibodies versus autoimmune disease     <a href="https://www.ncbi.nlm.nih.gov/pubmed/19963079" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pubmed/19963079</a></p></li><li><p>Immunoglobulin G <a href="https://www.sciencedirect.com/topics/neuroscience/immunoglobulin-g" rel="noopener" title="This link will take you away from steemit.com">https://www.sciencedirect.com/topics/neuroscience/immunoglobulin-g</a></p></li><li><p>Natural Antibodies Bridge Innate and Adaptive Immunity <a href="http://www.jimmunol.org/content/jimmunol/194/1/13.full.pdf" rel="noopener" title="This link will take you away from steemit.com">http://www.jimmunol.org/content/jimmunol/194/1/13.full.pdf</a></p></li><li><p>Serum IgG Subclasses in Autoimmune Diseases <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602543/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602543/</a></p></li><li><p>Kinetin Improves Barrier Function of the Skin by Modulating Keratinocyte Differentiation Markers<br>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/28223740" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pubmed/28223740</a></p></li><li><p>Desmocollin and desmoglein โ€“ different roles in desmosomes <a href="http://jcs.biologists.org/content/127/10/e1001" rel="noopener" title="This link will take you away from steemit.com">http://jcs.biologists.org/content/127/10/e1001</a></p></li><li><p>Learn more about Acantholysis  <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/acantholysis" rel="noopener" title="This link will take you away from steemit.com">https://www.sciencedirect.com/topics/medicine-and-dentistry/acantholysis</a></p></li><li><p>Potential Risk Factors for Cutaneous Squamous Cell Carcinoma 
include Oral Contraceptives: Results of a Nested Case-Control Study  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872290/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872290/</a></p></li><li><p>Pemphigus vulgaris presenting as gingival involvement  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505431/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505431/</a></p></li><li><p>When the Eyes Have It  <a href="http://www.pemphigus.org/when-the-eyes-have-it-2/" rel="noopener" title="This link will take you away from steemit.com">http://www.pemphigus.org/when-the-eyes-have-it-2/</a></p></li><li><p>Endemic pemphigus in the peruvian Amazon: epidemiology and risk factors for the development of complications during treatment  <a href="http://www.scielo.br/scielo.php?script=sci_arttext&amp;pid=S0365-05962012000600003" rel="noopener" title="This link will take you away from steemit.com">http://www.scielo.br/scielo.php?script=sci_arttext&amp;pid=S0365-05962012000600003</a></p></li><li><p>Overlapping IgG4 Responses to Self- and Environmental Antigens in Endemic Pemphigus Foliaceus <a href="http://www.jimmunol.org/content/196/5/2041" rel="noopener" title="This link will take you away from steemit.com">http://www.jimmunol.org/content/196/5/2041</a></p></li><li><p>A New Classification System for IgG4 Autoantibodies  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816565/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816565/</a></p></li><li><p>Autoantibodies in Senear-Usher Syndrome: Cross-Reactivity or Multiple Autoimmunity?<br>
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539423/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539423/</a></p></li><li><p>Pemphigus vegetans: An unusual presentation   <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505428/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505428/</a></p></li><li><p>Drug Induced Pemphigus  <a href="https://www.ncbi.nlm.nih.gov/books/NBK499864/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/books/NBK499864/</a></p></li><li><p>Drug-induced pemphigus <a href="https://www.dermnetnz.org/topics/drug-induced-pemphigus/" rel="noopener" title="This link will take you away from steemit.com">https://www.dermnetnz.org/topics/drug-induced-pemphigus/</a></p></li><li><p>Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives      <a href="http://www.ijdvl.com/article.asp?issn=0378-6323;year=2018;volume=84;issue=2;spage=137;epage=147;aulast=Ranugha" rel="noopener" title="This link will take you away from steemit.com">http://www.ijdvl.com/article.asp?issn=0378-6323;year=2018;volume=84;issue=2;spage=137;epage=147;aulast=Ranugha</a></p></li><li><p>Pemphigus vulgaris   <a href="https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris</a></p></li><li><p>Adverse effects of oral corticosteroids in relation to dose in patients with lung disease       <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746020/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746020/</a></p></li><li><p>Patterns of steroid and steroid sparing regimens among older 
inflammatory bowel disease (IBD) patients with contraindications to 
tumor necrosis factor antagonists (ANTI-TNFS)       <a href="https://www.valueinhealthjournal.com/article/S1098-3015" rel="noopener" title="This link will take you away from steemit.com">https://www.valueinhealthjournal.com/article/S1098-3015</a>(14)00294-0/fulltext</p></li><li><p>Azathioprine in the treatment of Autoimmune Blistering diseases     <a href="http://www.pemphigus.org/azathioprine-in-the-treatment-of-autoimmune-blistering-diseases/" rel="noopener" title="This link will take you away from steemit.com">http://www.pemphigus.org/azathioprine-in-the-treatment-of-autoimmune-blistering-diseases/</a></p></li><li><p>A comparative effectiveness research of azathioprine and 
cyclophosphamide on the clinical and serological response in pemphigus 
vulgaris  <a href="http://www.e-ijd.org/article.asp?issn=0019-5154;year=2016;volume=61;issue=4;spage=418;epage=426;aulast=Sardana" rel="noopener" title="This link will take you away from steemit.com">http://www.e-ijd.org/article.asp?issn=0019-5154;year=2016;volume=61;issue=4;spage=418;epage=426;aulast=Sardana</a></p></li><li><p>Medline ยฎ Abstract for Reference 5 of 'Initial management of pemphigus vulgaris and pemphigus foliaceus'   <a href="https://www.uptodate.com/contents/initial-management-of-pemphigus-vulgaris-and-pemphigus-foliaceus/abstract/5" rel="noopener" title="This link will take you away from steemit.com">https://www.uptodate.com/contents/initial-management-of-pemphigus-vulgaris-and-pemphigus-foliaceus/abstract/5</a></p></li><li><p>Methotrexate in the treatment of pemphigus vulgaris: experience in 23 patients      <a href="https://www.ncbi.nlm.nih.gov/pubmed/23772610" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pubmed/23772610</a></p></li><li><p>FDA Approves Genentechโ€™s Rituxan (Rituximab) for Pemphigus Vulgaris<br>
<a href="https://www.gene.com/media/press-releases/14727/2018-06-07/fda-approves-genentechs-rituxan-rituxima" rel="noopener" title="This link will take you away from steemit.com">https://www.gene.com/media/press-releases/14727/2018-06-07/fda-approves-genentechs-rituxan-rituxima</a></p></li><li><p>Dapsone in the treatment of pemphigus vulgaris: adverse effects and its importance as a corticosteroid sparing agent  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540507/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540507/</a></p></li><li><p>Effect of Intravenous Immunoglobulin Therapy on Serum Levels of 
IgG1 and IgG4 Antidesmoglein 1 and Antidesmoglein 3 Antibodies in 
Pemphigus Vulgaris    <a href="https://jamanetwork.com/journals/jamadermatology/article-abstract/420177" rel="noopener" title="This link will take you away from steemit.com">https://jamanetwork.com/journals/jamadermatology/article-abstract/420177</a></p></li><li><p>Plasmapheresis in Refractory Pemphigus Vulgaris: Revisiting an 
Old Treatment Modality Used in Synchrony With Pulse Cyclophosphamide    
  <a href="https://www.mdedge.com/dermatology/article/97747/wounds/plasmapheresis-refractory-pemphigus-vulgaris-revisiting-old" rel="noopener" title="This link will take you away from steemit.com">https://www.mdedge.com/dermatology/article/97747/wounds/plasmapheresis-refractory-pemphigus-vulgaris-revisiting-old</a></p></li><li><p>Pemphigus vulgaris  <a href="https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris" rel="noopener" title="This link will take you away from steemit.com">https://rarediseases.info.nih.gov/diseases/7355/pemphigus-vulgaris</a></p></li><li><p>Sun Exposure <a href="http://www.pemphigus.org/tag/sun-exposure/" rel="noopener" title="This link will take you away from steemit.com">http://www.pemphigus.org/tag/sun-exposure/</a></p></li><li><p>Photosensitivity <a href="https://www.ncbi.nlm.nih.gov/books/NBK431072/" rel="noopener" title="This link will take you away from steemit.com">https://www.ncbi.nlm.nih.gov/books/NBK431072/</a></p></li></ol>
๐Ÿ‘  , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , and 625 others
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@pokerm ·
$0.04
Fantastic blog. Kudos for all your research. I never heard of this disease before. Your postings are a credit to the Steemit community. Keep up the great work.
๐Ÿ‘  ,
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@agmoore ·
Thank you! I really appreciate that.  Thank you so much for stopping by and reading my blog.
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@chappertron ·
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Hey @agmoore2, this post looks pretty cool again. I will read it in detail tomorrow. Thanks & respect

Chapper
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@agmoore ·
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Thanks, @chapper, for stopping by.  I used a GIF to illustrate my point, but not a science GIF :)
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@chappertron ·
$0.05
No trouble about the non-science gif. The article is pretty cool again. At the first place, I was surprised to find a new disease I never heard before. But then a saw the term Usher. A friend of mine did research on the Usher syndrome and therefore I know these kinds of diseases are very rare. Because of this reason, unfortunately, not that much research is made and therefore again no good therapies are available. 

But it's good that you received a therapy that worked immediately without all these horrible side-effects or long-lasting suffering. 

Enjoy your Sunday

Best
Chapper
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@steemitboard ·
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@steemstem ·
$0.05
re-agmoore2-what-is-pemphigus-a--1559924705-20190609t063553940z
<div class='text-justify'> <div class='pull-left'> <center> <br /> <img width='200' src='https://res.cloudinary.com/drrz8xekm/image/upload/v1553698283/weenlqbrqvvczjy6dayw.jpg'> </center>  <br/> <br /> </div>

This post has been voted on by the **SteemSTEM** curation team and voting trail. It is elligible for support from <b><a href='https://www.steemstem.io/#!/@curie'>@curie</a></b> and <b><a href='https://www.steemstem.io/#!/@utopian-io'>@utopian-io</a></b>.<br /> 

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@agmoore2 ·
Thank you, Steemstem, very, very much!
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@utopian-io ·
$0.05
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@agmoore2 ·
Thank you, @utopian-io.  I'm very grateful.
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@lemouth ·
$0.06
18qcf2o9s
Wow! Such a personal post. I am impressed by the courage it should have required for you to survive the disease for more than 20 years (and maybe more?).  How is the research in potential treatments going? Any hope on this side to see something better and new?
๐Ÿ‘  , ,
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@agmoore ·
$0.07
Hi @lemouth, thanks so much for those kind words.  Not courage...an awareness of good fortune.  Mine was restricted to one lesion and the knowledge that this is part of my medical profile. The first time I went to the pemphigus specialist I was a bit frightened.  She told me that eveyone (there were many) who was in her waiting room had pemphigus and they were all doing fine.  They certainly looked fine.

In the US, as you know, one of the biggest issues in health is access to care.  In my case, that was never an obstacle. But for all autoimmune diseases, as a class, as you also know, there is little that can be done to control the course of *active*, refractory disease beyond some rather brutal drug regimens.  I think hope rests in looking at causes--those causes often rest in the environment. Many articles here on SteemSTEM address that.  I'm thinking of @chappertron and @scienceblocks in particular, who address epigenetic influences and how we might affect them.  SteemSTEM is a science library :)

I really appreciate your stopping by and commenting.  For me, feedback and networking are most rewarding.
๐Ÿ‘  , ,
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@lemouth ·
$0.12
79nfelgh7
I would have personally felt really scared if a doctor  would have asked me to come back for more tests. For some reasons, I usually always think about the worst option. And living in the US makes it even worse (as you said, this is a country where a decent health is somehow a luxury, in my understanding of you system).
๐Ÿ‘  , , , ,
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@scienceblocks ·
$0.06
This was an amazing post.  Reminded me of a similar disease I attended a meeting about.   The disease is called Epidermolysis Bullosa  or EB.  The one in which skin almost falls off and you have hard time even scratching yourself in peace,  because that will make lesions come up. I was horrified after meeting those patients,  it was so painful. Turns out PV is in the list of differential diagnosis for EB.  Like you mentioned PV and related diseases occur because of autoantibodies attacking the proteins that keep the structure together, EB happens because of mutations in genes like keratin 5 or 14,  col7, proteins of basal lamina. 

Anyway,  glad to hear that you are doing ok now.  Stay stress free and eat healthy.  Hope it never returns back.  

Thanks for sharing this.

Posted using [Partiko Android](https://partiko.app/referral/scienceblocks)
๐Ÿ‘  , ,
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@agmoore2 ·
$0.03
Thank you so much.  Your kindness always shines through your writing. Putting together a science article for me is a little like going back to school.  I know some things and have to learn much more.  That for me is a relaxing exercise.  And there's always the chance someone will read the piece and get something useful out of it.  When my articles pass muster in the science community--that is gratifying.  

I think I told you in a comment once that my family has a peculiar experience with autoimmune disease.  I won't give the list here...but my brother was struck with *voltage gated potassium channel autoimmune limbic encephalitis* a few years back.  The usual weapons--massive doses of corticosteroids and immunoglobulin brought him back(mostly).  He also benefited from being near an excellent medical facility (Emory University) and having the resources to access care.

It would be nice if we could more precisely understand the nexus between environment and genetics *before* a pathology developed.  And it would be really nice if everyone had the means to take your advice:  stay stress free  and eat well.  Unfortunately, we're a long way from both goals.
  
I wish you and your family good health.  Have a most peaceful day.
๐Ÿ‘  ,
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@alexander.alexis ·
$0.12
iywx0rpom
Oh boy. Lucky indeed, in your unluckiness.

> chives, garlic, onion, black pepper, cashew and mangoes

Interestingly, all of those (except black pepper) are not to be eaten on the low-FODMAP diet, a common recourse for those with gastrointestinal issues. One more thread in the gut-autoimmune connection, I guess.

That's a veritable hat fetish you have there!
๐Ÿ‘  , , , ,
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@agmoore2 ·
$0.03
a081fvr40

He He.  Half of those hats were gifts.

And that gut connection...oh yeah. 
Thanks for stopping by, @alexander.alexis :)
๐Ÿ‘  
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@alexander.alexis ·
$0.12
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I just read this in the book The Paleo Approach: "Celiac disease, multiple sclerosis, dermatitis herpetiformis, and bullous pemphigoid have been definitively linked to gluten as an environmental trigger."

I assume you don't eat gluten? I remember you mentioned not getting along with fiber.
๐Ÿ‘  , , , ,
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@erh.germany ·
$0.04
I am sorry, I missed this post to give a vote :( But I recently am seldom on steemit. 

It is astonishing that one can find causes and methods of treatment at all, in the multitude of illnesses and then also establish the connection to medication. 

I'm not sure whether it was good fortune that made you overcome this disease, even let you survive. You know that I am convinced that bodily functions are also mentally influenced and that stress is a factor that can influence the course of a disease, as has already been said here in the comments section. The body initially responds with strange disturbances when a person behaves against his needs. In connection with a recent family autoimmune disease, I have read that permanent tension - literally understood here - makes the organs' work more difficult and that an abdomen that is in a permanent state of tension favours diseases. If, for example, you do not integrate regular meal breaks into your working hours, eat on the side, eat your food in a hurry, you disturb the work of the organs and the processes in a way that could be compared to a sloppily written essay. Punctuation, semantics do not follow the rules. If the flow and working processes in the body are blocked, if the substances cannot be qualitatively converted or transported, the body will eventually turn against its host. 

Therefore, my question to you would be whether you have changed your eating habits in the context of the diagnosis, not only what you eat, but also how you eat. Slow chewing, preparing food better for the stomach, several small meals instead of big ones, etc.? From my point of view, eating in company or alone also makes a big difference in how fast or slow you eat your food. I mainly eat alone, I have to force my son to sit down at the table and take it consciously. Whenever I live among several people, I feel better overall, because I eat more regularly and feel more happy preparing the food when six people sit at the table instead of two. 

All this said, I know that all the other reasons you mentioned are valid, but as always, I wanted to add my point of view. 

I like your hats! I myself have a sun allergy since round about four years. I must wear long sleeves, as it's my hands which suffer the most. But I also must protect my face as I easily get sun burned but without the itching consequences my hands endure. My man recently gifted me a sun protector which, for the first time, not only protects my hands but also has a healing effect on the skin. It's from eco cosmetics, 100% natural origin, 98% organic vegetal, 28,6 % organic:
https://www.naturdrogerie.shop/eco-cosmetics/sonnenlotion-neutral-lsf-30-ohne-parfum

only German, sorry.
๐Ÿ‘  
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@agmoore2 ·
$0.06
So nice to see you, Erika.  I think we might be related &#128526;
What you say about stress is so true.  I lead a quiet life, even a privileged life.   I think the major stresses in my life occurred long before I had control--and those early stresses do take a toll, later on. 

Eating...not too much folly there :).  Not anymore, anyway &#128578; 

Your hands...interesting.  Is it just sun, or temperature also?  There's something called [Reynaud's](https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Raynauds-Phenomenon) syndrome in which hands are affected by changes in temperature.  

Thanks for that link to the sunscreen. Usually titanium dioxide and zinc oxide are good (no reaction) for me, but generally the recommendation is to avoid sun exposure as much as possible.  @alexander.alexis had a thought: maybe I was a bat in my past life &#128517;

Be peaceful, and well.
AG
๐Ÿ‘  ,
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@erh.germany ·
$0.04
It's clearly the UV and allergy against sun light. I only get it in summer when I expose myself too much to the light. My brother gets it, too. Skin sensitivity is something the whole family lives with. Guess, you and me might stem from a bat family. LOL. 

Speaking of sun: today is a lovely day and we will visit again the STAMP Festival, as every year. Unfortunately there are less artists and more consumption.

Kisses!
Erika
๐Ÿ‘  
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created2019-06-16 07:56:48
last_update2019-06-16 07:56:48
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root_title"What is Pemphigus? A Personal Perspective"
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vote details (1)