Clinical presentation and diagnostic delay in pemphigus vulgaris: A prospective study from Turkey.

Abstract

To evaluate the diagnostic patterns and factors that may influence delays in the diagnosis of pemphigus vulgaris (PV) with oral involvement. In this prospective cohort study, 36 newly diagnosed PV patients with oral involvement were clinically examined and interviewed about the natural history of the oral lesions, number of medical consultations (Med consultation), medical treatment history, and diagnostic delay time (DD time). Thirty (83%) PV patients presented initially with oral mucosal involvement (OMI) and 6 (17%) presented initially with skin involvement (SI). The mean DD time was 6.19±3.82months, and the mean number of Med consultation was 5.8 (n=36). The means of all the parameters were significantly higher for the OMI patients than for the SI patients (P<.05). All of the patients with OMI had been misdiagnosed. The DD time was significantly longer in patients who presented initially with desquamative gingivitis (8.25±3.81) than patients who presented with ulcers and erosions (4.78±1.11) (P<.05). There was a statistically significant positive correlation between DD time and Med consultation (r=0.91). Even with the high frequency of oral involvement and easy access to the oral cavity, diagnostic delays are still common for patients with oral PV. This underlines the need for education to improve healthcare providers' awareness and knowledge of the clinical oral presentation of PV.