The aim of the current preliminary case-control study was to estimate the initial serum levels of tumor necrosis factor α (TNF-α) in case patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF) and correlate them with history of stress, body surface area (BSA) affected, disease severity, and disease outcome. Ten PV and 4 PF case patients as well as 7 healthy matched controls had their serum levels of TNF-α measured by an enzyme-linked immunosorbent assay. Case patients were treated and followed up for 2 months. A statistically significant elevation in serum levels of TNF-α in PV case patients compared with controls and in PV case patients compared with PF case patients was detected (P<.05), with no significant difference between PF case patients and controls (P>.05). No significant correlation was detected between the serum levels of TNF-α and the BSA affected (P>.05). Four PV case patients had a bad disease outcome, of which 3 had severe emotional stress a month prior to the onset of the attack. All 4 showed significantly elevated initial serum levels of TNF-α compared with those who had a good disease outcome (P<.05).
Emotional stress is a factor affecting prognosis of the disease. Pretreatment assessment of serum TNF-α levels in patients with pemphigus may be a guide to the expected prognosis and selection of the proper treatment regimen.