Author Archives: Will Zrnchik

Will-Web-headsotWelcome to the final issue of 2014. It’s been an exciting year for the IPPF and we hope 2015 brings more of the same. I’d like to welcome Todd Kuh to the IPPF Board of Directors. Todd is a PV patient from Southern California and avid cyclist.

Our 2015 Patient Conference will be in New York City at Mount Sinai Hospital, April 25-26, 2015. Dr. Annette Czernik is helping plan the event and Biofusion is sponsoring our Friday Night Conference Kickoff, April 24, 2015, with dinner and refreshments at Yankee Stadium.

You may have seen a letter in the mail from my good friend Dave Baron asking you to support the IPPF. I met his father and sister at our 2006 Annual Meeting because he couldn’t make it (his PV made travel impossible). The IPPF helped him find a doctor, educated him on treatments, and supported him every step of the way. Now in remission, Dave doesn’t want patients to suffer like he did. Join him and his family with a generous gift to the IPPF this Holiday Season at

A Quick Recap

In 2014 the IPPF celebrated our 20th Anniversary. Noelle Madsen and Patrick Dunn joined our team (and Todd with the BOD). The Patient Education Series launched revamped Patient Education Calls averaging 75 registrations each. Our Patient Conference had 125 attendees and raised over $18,000. Social media grew nearly 1,000%. 450+ patient cases were closed. We supported 8 pieces of legislation benefiting patients. A dozen local support group meetings were held. The Physician Referral List grew 5%. The Awareness Campaign (AC) formed a Dental Advisory Council. We finalized patient and physician videos. We are supporting clinical trials. The AC presented at the American Dental Association and to dental students at Indiana University, conducted focus groups, and was published in the American Dental Hygienists’ Association’s Access Magazine. The Awareness Ambassador Program launched. We unveiled our new website in August and the Awareness Campaign’s in December. And I could go on!

What’s in store for 2015?

Rare Disease Day. National Autoimmune Disease Awareness Month. Patient Conference. Patient Education Calls…and videos! New printed and downloadable information. Awareness Ambassadors. Patient Advocacy tools. New ways to support the IPPF. Dental Professional and Student Education. And much, much more!

It’s an honor to serve this wonderful community of friends and family.

My family, and the entire IPPF family, wishes you and yours a safe and Happy Holiday Season!



If you’re like me you do a lot of shopping online. It’s convenient. It’s safe. And sometimes the prices just can’t be beat. To make sure I get a great deal from a reputable company, I do most of my shopping through AmazonSmile (, part of

My AmazonSmile homepage

My AmazonSmile homepage

AmazonSmile ( is a simple and automatic way for you to support the IPPF every time you shop, at no cost to you. When you shop at, you’ll find the exact same low prices, vast selection and convenient shopping experience as, with the added bonus that Amazon will donate a portion of the purchase price to the IPPF.  To shop at AmazonSmile simply go to from the web browser on your computer or mobile device. You may also want to add a bookmark to to make it even easier to return and start your shopping at AmazonSmile.

There are tens of millions of products on AmazonSmile are eligible for donations. You will see eligible products marked “Eligible for AmazonSmile donation” on their product detail pages. Recurring Subscribe-and-Save purchases and subscription renewals are not currently eligible.

The circled area lets you know the product is an AmazonSmile participating product.

The circled area lets you know the product is an AmazonSmile participating product.

It’s easy to use because you use the same account on and AmazonSmile( Your shopping cart, Wish List, wedding or baby registry, and other account settings are also the same. When you visit AmazonSmile ( for the first time you need to select the International Pemphigus Foundation to receive donations from eligible purchases before you begin shopping. Amazon will remember your selection, and then every eligible purchase you make at will result in a donation to the IPPF.


78_mac-slider2_optFall is a time most clothing designers live for. They spend months creating new styles to be modeled on runways in New York, Milan, and Paris hoping to have the “must have” look of next Spring or Summer.

This Fall we present a new look from Sacramento tech-firm Uptown Studios ( for the IPPF that will be on computers, tablets, and phones around the world. After months of sketches, wire-frames, and coding, I am very excited to announce our new website:

The new site is easier to navigate and features resources and support at your fingertips. The “responsive” design keeps its look and feel no matter what screen size. We added accessibility features like variable text sizing and a high-contrast display. Our social media links, search box, and donation button are conveniently located at the top of each page. Our home page features a testimonial section. Read what others have to say about the IPPF. You can also submit your own story to be shared on our site!

A big part of our mission is support. In addition to the Email Discussion Group, RareConnect community, and social media sites, we added support.

Our Patient Support team can now provide fast, awesome customer service on a modern, flexible platform over various channels. Patients and caregivers can find answers in the self-service portal using existing FAQs, email questions to our PHCs, or post to the general community. And when they are online, you can chat live with a PHC!

I am also excited about the Awareness Campaign portal currently being developed. It will contain resources and information for dental professionals and Awareness Ambassadors. Our goal is to keep P/P on the RADAR of dentists and provide them with tools and training needed to reduce P/P diagnosis time and increase your quality of life.

For some people, the end of Summer means the start of school. Here at the office “Back to School” means helpful happy interns. Several interns from Sacramento State University and Cristo Rey High School (Sacramento) are working on website articles, informational materials, the Awareness Campaign, and more. Our Sac State interns are in health-related programs and our high school interns are part of a Work-Study program. The work done by them saves the IPPF thousands of dollars each year while giving them real-world experiences.

Volunteerism is on the rise! Daphna Smolka is working with us on a P/P friendly cookbook that will be also be a P/P Community effort. Tina Lehne is spearheading the Awareness Ambassador effort and preparing the program’s requirements and materials. Marketing guru Edie DeVine is helping with our public messaging and press releases. Dr. Maulik Dhandha is working on a paper reporting on the diagnostic delays of P/P we hope to publish in an academic journal.

And speaking of journals, members of our Medical Advisory Board joined 30 other physicians in finalizing an MMP consensus statement providing clearer definitions and outcome measures for accurate and reproducible definitions for disease extent, activity, outcome measures, end points and therapeutic response. Thank you Prof. Dedee Murrell and Dr. Victoria Werth for leading this effort.

This issue of the Quarterly is another great one! PV patient Martha Cusick was so happy with the help she received from her Peer Health Coach, she set a goal to fundraise for research and awareness (p. 4). And what do you do when you need a cancer treatment, but getting it will cause a severe flare? Read Joan Blender Ominsky’s story on page 15.

The Awareness Campaign has a new look, more help, and a catchy slogan. Kate Frantz keeps you up to date starting on page 6. Clinical psychologist and PV patient Terry Wolinsky McDonald explains the Nuts & Bolts of Depression (p. 7). The discovery of VH1-46 is the topic of two articles (pp. 8 and 9). Two P/P experts discuss the importance of measuring patient quality of life (p. 11). And we have another delicious Vicky Starr recipe on page 19!

Lastly, I hope to see you in New York for our 2015 Patient Conference. The Committee is busy finalizing the date (end of April) and venue (near Central Park). Keep an eye on your mailbox and inbox for more information in the coming months! I promise this event will be BIG!

To Anna, the IPPF means hope when all hope was gone. For Steve, the IPPF means discovering hundreds of other patients when he thought he was alone. And Jack — Jack says he owes the IPPF his life. To me, the IPPF means helping my ‘pem-family’ find comfort, strength, and support through our dedicated staff and volunteers. Phone calls and emails come in to our offices every day. Between the new patient calls and flare-up questions, there are little rays of sunshine that bring hope. Thousands of people around the world re- member their first call, how the IPPF was there for them, and what the IPPF means to them. Now it’s your turn. Please contribute to the IPPF this Holiday Season. Your donation funds essential, life-saving programs and services such as the Regis- try, Peer Health Coaches, Awareness, and more. And now you can be a Sustaining Donor! Our organization is lean, so a higher percent- age of your money goes directly to the programs we offer and the re- search initiatives we sponsor. You can safely donate online at or use the form below. As I look back over the past year, I remember how many members of my pem-family I have talked with and helped with the gift of hope. I know for our Peer Health Coaches that number is even higher. This holiday season give the gift of knowledge, support… and hope. Happy Holidays and Happy New Year!
‘Tis the season for giving thanks and celebrating the holidays with those we love. Things  can become so hectic that we forget to thank those around us for being a part of our lives. Personally, I am thankful for my parents and their advice over the years. “Bird” and “Pops,” as they are affectionately referred to, were never short on tough love or supportive words. I thank my love- ly wife, Christina, for her loving support and encouragement that make me a better person. I am thankful for my children, Will, Haley, Alannah, and Noah, and hope each of them support causes dear to their heart. I thank Janet Segall for bringing me into the IPPF and our Board of Directors for giving me the opportunity to work with our won- derful coaches, advisors, and patients around the world. The un- derlying theme: I am thankful for the support of others and do my best to pay it forward. The IPPF does more than support patients — it supports caregiv- ers, family, friends, and physicians. Thank you to Marc Yale and our Peer Health Coaches who collectively have closed more than 500 cases this year answering calls, emails, and postings from people all over the world. Many of our “veteran” patients still remember that scared feeling they had before calling the IPPF and how relieved they felt after receiving support and information. They now pay it forward, helping others in our community. Recently, a newly diagnosed patient’s daughter called the office. You could hear the relief in her voice when I told her, “Your mom will be fine. Now let’s focus on helping you understand the disease and treatments.” After, she sent me an email thanking me for the in- formation, but more for just taking the time to talk to her. I replied: “No, thank you for calling.” Yes, thank you for the calls, emails, and interactions that allow us to support one another. You should feel good knowing your involve- ment helps others at a time when they need the IPPF most. From my family to yours, have a safe and joyous holiday and a Happy New Year! From the Top Will Zrnchik Chief Executive Officer PS: Help us continue our important work by donating today. Contribute online at or use the form on page 13. International Pemphigus & Pemphigoid Foundation2 POSTMASTER: Highway #100, Sacramento, CA 95833, United States of America. The Quarterly is published four times a year in the Spring, Summer, Fall and Winter and provided free of charge to donors as a thank you for their support. The material presented in our journal is not intended as medical advice. Readers are urged to consult their physicians before making any changes in their health regimen. The contents of the Quarterly cannot be reproduced or copied without written permission of the IPPF. All inquiries regarding material from this publication should be directed to: IPPF, Attn: Rights and Permissions, 1331 Garden Hwy #100, Sacramento CA 95833, USA. We are able to reproduce articles and provide electronic copies of issues. The cost for this service varies based on the amount and type of media preferred.  If you are interested in submitting a story for print consideration, please contact the IPPF prior to submitting your story. Our staff will assist you in preparing your article for future publishing in an issue that relates to your topic. BOARD OF DIRECTORS David A. Sirois, DMD, PhD Rebecca Oling, MLS Lee A. Heins William Gerstner Dan Goodwill Badri Rengarajan, MD Sonia Tramel Mindy Unger Terry Wolinsky McDonald, PhD J. Gregory Wright, MBA MEDICAL ADVISORY BOARD Victoria Werth, MD Sergei Grando, MD, PhD, DSci Russell P. Hall III, MD Takashi Hashimoto, MD Michael Hertl, MD Pascal Joly, MD Marcel Jonkman, MD, PhD Neil Korman, MD, PhD M. Peter Marinkovich, MD Dedee F. Murrell, MD Animesh A. Sinha, MD, PhD David Sirois, DMD, PhD Robert A. Swerlick, MD ADMINISTRATIVE STAFF AND SUPPORT William Zrnchik, MBA, MNM Kevin Cruz PEER HEALTH COACHES Marc Yale, Sharon Hickey Jack
Do you suffer from severe limitations in your dai- ly activities because of your disease? Then you are among the 11% who are able to minimally per- form regular, daily routines. And if you suffer from any limitations in your daily activities as a result of your medication or treatment, you are among the 68% who said they have mild, moderate, or severe limitations. We know because over 700 people told us so! The IPPF Registry ( provides us with a patient’s diagnostic and treat- ment experience information. With more data, the IPPF will be in an influential  position with policy makers and insurance providers. During the 2012 Annual Meeting, IPPF President Dr. David Sirois said, “The thing that empowers an organization is information.” This simple statement captures the IPPF’s goal of advocacy and awareness: providing information to clinicians, researchers, and insurance providers to make more informed de- cisions with regards to pemphigus and pemphigoid patients. Dr. Sirois challenged attendees to join the Regis- try. Now, I am asking you to do the same: JOIN THE REGISTRY. We need your help. “That registry is vital to our organization’s posi- tion, and our next step is to publish these findings in peer-reviewed journals, such as the Journal of In- vestigative Dermatology.” Once we do that, other scientists, researchers, and clinicians can use this important data so we can change perceptions and practice to benefit patients everywhere. Yet we have not reached our magic number of 1,000. We have 721 — out of thousands of patients around the world — who stood up and said, “I want to make a difference!” YOU can change how pemphigus and pemphigoid patients are diagnosed and treated in just 15 min- utes. Remember, your personal information is NEV- ER shared with anyone for any reason. The information we have is great, but without more involvement from pemphigoid patients, IVIg users, and men in general, we are only seeing part of the picture that could change everything.

Here are some Fast Facts from the Registry:

• 73% of all P/P patients are female

• 65% of all P/P patients have PV (11% have BP) • 11% also have thyroid disease (5% have rheu- matoid arthritis)

• 70% see only a dermatologist — even though 41% have current lesions in their throat/mouth.

As you can see, the information is compelling, but if this does not reflect you, then we need your data! The data can be segmented by gender, age, and disease type (see A Look at PV from Inside the Regis- try on the previous page). The goal of 1,000 will make our Registry the largest collection of pemphigus and pemphigoid data available to researchers. Please do your part to help patients everywhere. For more information, or to participate, please visit

Can you believe the 2012 Holiday Season is a few calendar page turns away? I barely remember Summer beginning — let alone ending in a few weeks.  But here we are in September and the whirlwind of activity throughout our community has kept us busy. The IPPF has a new home and our good friend and IPPF Founder Janet Segall, paid us a visit. She liked the atmosphere and accommodations and asked me to tell everyone hello, so, “Janet says, ‘Hello everyone!’” The IPPF Fundraising Committee has been successful in get- ting funds for our Awareness Campaign (see page 8). Since most P/P patients have oral lesions, this three-year awareness program targets dentists in training and in practice with the hopes of reducing the diagnosis time from the five-physician, 10-month cycle to a single visit (maybe two) during the first few months. Keep up the great work, Team! Our Registry is key to unlocking the mysteries of pemphigus and pemphigoid.

The information we have is compelling, but more information is better. I ask each of you to take 15 minutes and complete the Registry. We need FEWER THAN 300 more people to surpass 1,000 participants and give researchers a better understanding of P/P. Your contact information is NEVER shared and when we look at the responses, all we see is a number, not a name; a state/province, not an address. Can YOU help us pass 1,000 by the next issue? I think you can at The 2013 Patient Conference (formerly the Annual Patient/Doctor Meeting) will be in San Francisco, April 26-28, 2013. The Planning Committee is looking to capi- talize on the success in Boston — and we think San Francisco is the place to do it. If you have never been to the Bay Area, there is no better time that April 2013. And if you live in the Bay Area, join us at Stanford September 29, 2012 for the Bay Area Sup- port Group Meeting (11 am – 2 pm, The Holiday Fundraiser will be gearing up in a couple of months and I am challeng- ing each and every one of you to find one person to match your donation. Imagine if 2,000 people gave just $50 — and their one friend gave $50. These donations will af- ford us the opportunity to have more Peer Health Coaches to answer your questions, more informational materials for physician offices, more educational materials for patients – and the list goes on … but we need your help to make 2013 bigger and bet- ter than 2012. And don’t forget you can now give a monthly amount  that is automat- ically deducted from your credit card. How about giving $25 a month instead of $100 all at once? It’s just as easy and makes a big impact for us – and a bigger tax deduc- tion for you! You can always donate online at Thank you for your continued support and we hope you enjoy this issue.

Can you believe Summer is here? The days have flown by in a whirl- wind of activity here at the Foundation and I would like to take a moment to fill you in on what is in the works. In case you have not heard, the 2012 Annual Meeting in Boston was a resounding success. It was a true team effort from Planning Day 1 through Sunday’s closing remarks. We ended up with nearly 275 attend- ees, speakers, and volunteers – more than any other meeting in our his- tory!

Attendees included patients in remission for 20+ years, to a patient diagnosed a few days before the meeting started. If you were there, then you already know how incredible this meeting was — and the fireworks were truly a coincidence!

If you were not able to attend, then you missed a doozy, but fear not: everyone can visit and get copies of the program, presentations, and available audio. I would like to personally thank everyone who helped make this meeting possible – and the success it was! Turn to page 7 and see who made the 2012 Annual Meet- ing THE meeting to top! And don’t forget to mark your calendars: the 2013 Annual Meeting will be in San Francisco, April 26-28! Dr. Terry Wolinsky-McDonald’s “Psychologically Speaking” column will return next issue. If there is a topic you would like her to cover, please email her at As we move into the second half of the year, the IPPF is focusing on in- creasing physician awareness. Remember when you, or someone you know, was first diagnosed with pemphi-what? Were you one of the lucky ones who was diagnosed in less than a month? Or even less than three? Most are not that lucky.

In 2011 the IPPF funded a study to determine how long it takes new patients to be diagnosed. The results indicat- ed patients see an average of 5 doctors over a 10-month span before receiving a proper P/P diagnosis. This does not have to be! With the right information available to physicians, patients could be di- agnosed in days or weeks, not months or years. Our goal is to increase pemphigus and pemphigoid awareness in the medical professions. During March 2012’s National Autoimmune Disease Awareness Month, we raised almost $10,000 towards P/P awareness. In April 2012, the IPPF was awarded a $15,000 grant from the Sy Syms Foundation to help with our Awareness Campaign! And recently, a special do- nor has pledged even more towards our awareness efforts! But we are not there yet! Awareness campaigns DO work! To get the most coverage among dermatol- ogists, dentists, and other specialties, we need your help! This summer we are asking everyone to con- sider a tax-free contribution specifically for our Awareness Campaign. You can donate online at, call our offices at (916) 922-1298 ext 1003, or mail in the form located inside the back cover. Please consider asking a friend or family member to support this very important effort. And don’t forget about Matching Gifts from your employer! Con- tact your Human Resources department for more information. The sooner we can fund this project, the sooner we can increase physician awareness — and the sooner pemphigus and pemphigoid patients will be diagnosed and treated. That means patients can begin their journey to recovery and remission sooner than ever before! Finally, thank you for your continued support and have a safe and happy Summer!!

With the Boston skyline as a backdrop, the IPPF’s 15th Annual Meeting kicked off with more than 100 people gathering for Friday night’s Welcome Recep- tion. The Hyatt Harborside Hotel captivated long- time Boston residents with its beautiful view of Bos- ton Harbor and picturesque city skyline. Guests came from near and far to join in our yearly social gather- ing of patients, caregivers, and physicians. The room was buzzing with talk of the weekend’s events as peo- ple shared their stories among friends. SATURDAY Saturday morning began with host Dr. A. Razzaque Ahmed (Director, Center for Blistering Diseases) wel- coming everyone to Boston followed by a congratu- latory video message from Massachusetts Governor Deval Patrick. Newly appointed CEO Will Zrnchik welcomed at- tendees, many of whom came filled with hope for in- formation and answers. He highlighted why people travel from all over the world to be part of these meet- ings: a common hope | an uncommon bond.

Next, IPPF President Dr. David Sirois (New York University) began with a cheerful welcome and an update on the IPPF. As an ultra-orphan disease sup- port organization, the IPPF “sees its primary mission to connect together the different parts of the com- munity that together can give [patients] a better ill- ness experience.” Dr. Sirois invited attendees to par- ticipate in Town Halls, Annual Meetings, the Email Discussion Group, Patient Forums, Facebook, the Pemphigus & Pemphigoid Disease Registry, and IPPF studies and surveys. He then discussed the results of a recent IPPF study that showed delays for initial diagnosis, including a patient seeing five physicians over a 10-month pe- riod.

Dr. Sirois al- so discussed the cor- nerstone of the IPPF’s 2012 efforts: the IPPF Awareness Campaign. This program will focus on physicians in training and in practice to increase recognition of these diseas- es, provide guidelines for treatment and care, and bring new clinicians into medical dermatology committed to bullous diseases through fellowships and scholarships. The opening talk was given by Dr. Grant Anhalt (Johns Hopkins University), who provided a brief overview on pemphigus and pemphigoid. Dr. Anhalt was instrumental in helping Janet Segall found the National Pemphigus Vulgaris Foundation in 1994 (today known as the International Pemphigus Pemphigoid Foundation). Dr. Anhalt’s discussion covered how the immune system uses antibodies against antigens. He also mentioned that autoim- mune diseases are the third most common group of diseases behind cardiovascular diseases and cancer. Dr. Anhalt mentioned how none of the drugs used to treat the disease can be used to treat the target area, but must focus on getting rid of the antibody produced by the immune system. Next, legendary pemphigus and pemphigoid phy- sician Dr. Samuel Moschella (Lahey Clinic Medi- cal Center) told attendees what it was like to treat pemphigus before prednisone was available. His stories of varying treatments and therapies of pemphigus vulgaris malignus were met with silence as he mentioned “70-90% of these patients died from this disease” as a result of infection, malnu-trition, or other elec- trolyte and protein problems, and how it was treated much like burn victims. As Dr. Moschella’s story moved along his time line, the introduction of better therapies and an increased understanding by physicians improved treatment. The first dental talk of the day was given by Dr. Sa- dr Kabani (STRATA Oral Pathology Services) on the oral manifestations of pemphigus. Dr. Kabani men- tioned pemphigus may begin with canker sore-like lesions on a localized area of the gums or inside of the cheek, that can become progressively worse. A com- mon site of involvement is the soft palate. Gum in- volvement is common and might be the only manifestation. Diagno- sis is based mostly on clinical presentation, but must be confirmed by a biopsy and immunoflorescence. Dr. Sook-Bin Woo (Harvard Dental School) dis- cussed the clinical presentation and diagnosis of pemphigoid in the oral cavity. Dr. Woo opened with how pemphigoid is of- ten associated with eye and skin lesions, but more often than not it is associated with purely the oral region, and typically female. She mentioned that blisters are not commonly visible because they rup- ture frequently, so peeling mucous membranes are a good indication. Dr. Woo said a biopsy is a must in properly diagnosing pemphigoid in the mouth. She said 95% of her patients are oral only without skin or eye involvement, but does not rule those areas out until af- ter the patient sees a dermatolo- gist and ophthalmologist. Attendees were then free to at- tend one of seven breakout ses- sions, or workshops. The morn- ing’s sessions focused on oral issues, topical management, and coping with pemphigoid. After- wards, everyone enjoyed a scenic luncheon outdoors in the Grand Pavilion before returning for an afternoon of systemic informa- tion. Dr. Kunal Jajoo (Brigham and Women’s Hospital) began with a talk on esophageal involvement of pemphigus and pemphigoid. The diagnosis of esophageal in- volvement involves radiology and endoscopy. In the majority of pa- tients he cares for, the primary disease has been diagnosed, so he focuses on if there is esophageal involvement using tests like the Barium Swallow (a patient drinks a chalky milk-like substance com- prised of a metallic compound that shows up on x-ray). He also mentioned careful consideration must be given before biopsying the esophagus so not to cause fur- ther damage, unless the diagno- sis is uncertain or the results will change disease management. Next was a presentation on oc- ular involvement by internation- ally recognized eye specialist Dr. C. Stephen Foster (Massachusetts Eye Research and Surgery Insti- tute (MERSI) and Harvard Med- ical School). He gave a basic over- view of the eye, and how the bulk of the oc- ular area is not af- fected by the blis- tering, but how it is focused on conjuncti- va (the lining of the eyelids and the whites of the eye) and the cor- nea itself. Unlike the skin, the eye is very unforgiving of chronic in- flammation and, therefore, thera- py should be aggressive for MMP patients with eye involvement.

Vice Chair of the IPPF Med- ical Advisory Board Dr. Sergei Grando (University of Califor- nia – Irvine) spoke about system- ic corticosteroids and if they are “friends or foe.” It is important to learn that prednisone can be your friend. It has reduced the mor- tality rate of pemphigus to 5-12% when used with a steroid sparing agent/reg- imen such as cytotoxic drugs, pro- tein inhibi- tors, or IVIg. Dr. Grando pointed out that prednisone mimics the body’s production of cortisone acetate (the adre- nal gland produces 35-40 mg/ day, which is equal to 7-8 mg of prednisone). However, when doses are too high or too low, or non-responsiveness is not recog- nized, systemic corticosteroids can become a foe.

This can lead to enhanced appetite, fluid and salt retention, emotional disor- ders, diabetes, hypertension, and more Our first international plenary speaker was Dr. Richard Groves (St. John’s Institute of Derma- tology, London). He presented on immunosuppressive agents, and when a physician should choose which one when treat- ing pemphigus and pemphigoid. Dr. Groves said the aim of adju- vant immunosuppression is to achieve great disease control with minimal adverse effects. These steroid sparing agents include azathioprine, mycophenolate mofetil, cyclophosphamide, sulfa drugs, and tetracyclines, among others. Dr. Groves continued with a detailed discussion on effective options, treatment based on the diagnosis and severity, genetics, and how adverse effects are well understood and controllable. Dr. A. Razzaque Ahmed (Center for Blistering Diseases) returned to the stage to discuss IVIg and rituximab use in autoimmune blistering diseases. These treat- ments are an area of controver- sy and lack uniformity of opinion and therapy. Dr. Ahmed talked about the IVIg treatment proto- col developed by 35 experts from the US, Canada, and Europe (pub- lished in 2003). He stressed with IVIg “there is an endpoint to the therapy…there is light at the end of the tunnel.” Dr. Ahmed stated IVIg and rituximab, alone or in combination, have shown signif- icant benefit and newer diseases’ specific biological agents will be discovered once there is a better understanding of the pathogene- sis of blistering diseases.

Next began the afternoon breakout session (workshops) focused on side effects, ocular pemphigoid, IVIg, genetics, treat- ing blistering diseases differently, and coping with pemphigus. This was followed by a short question- and-answer session with the day’s speakers (see page 14 for some of the questions). SUNDAY Sunday brought out the scien- tist in everyone as the speakers discussed updates, advances, and new therapies. Opening the day was IPPF Med- ical Advisory Board Chair Dr. Vic- toria Werth (University of Penn- sylvania) providing an update on the classification of pemphigoid. Since pemphigoid is a sub-epi- dermal blistering disease, there is a need for standard terminology and severity measures. Based on the number of studies and lack of uniformity among terminology, it is nearly impossible to compare therapeutic outcomes using sim- ple meta-analysis. Currently, sev- eral bullous disease experts are working on a Bullous Pemphigoid Disease Area Index (BPDAI) to standardize scoring and termi- nology, thus making it easier for scientists, researchers, and clini- cians to share information. How- ever, further studies are needed to validate this information, as well as validation of eye and ENT scores. Next, Dr. Ahmed introduced Dr. Grant Anhalt  as the “Grandfather of Paraneoplastic Pemphigus,” a title unofficially bestowed upon him since he was one of the first to describe it in 1990. During his talk on PNP, and using several index cases, Dr. Anhalt discussed the history, exam, and treatment plans needed to help the patients. He said most PNP cases are mis- diagnosed as chronic erythe- ma multiforme, toxic epidermal necrolysis, and combined lichen planus – and he estimates as many as 75% of cases are still not prop- erly recognized or diagnosed. Dr. Anhalt then discussed why PNP looks and acts differently than pemphigus vulgaris, and how the mortality rate is nearing 90% be- cause it is the most treatment-re- sistant disease. Dr. Peter Marinkovich (Stanford University) discussed laminins in skin diseases. Dr. Marinkovich noted that Laminin-332 is ab- sent in a severe, inherited blis- tering disease. Laminin-332 is an important adhesion molecule and target- ing the en- tire protein would cause widespread blister- ing. Therefore, selectively target- ing Laminin-332’s carcinoma pro- moting regions does not interfere with tissue adhesion. Dr. Marcel Jonkman (Univer- sity of Groningen, The Nether- lands) presented on the patho- genesis of bullous pemphigoid. While pemphigus has document- ed findings dating back to 1768, pemphigoid was not indepen- dently distinguished until the ear- ly 1950s. Dr. Jonkman discussed the histopathology, diagnostic al- gorithm, and autoantigens of BP. He also mentioned the role of IgE and how it is faintly detectable in the epidermal basement mem- brane zone (BMZ) of a BP patient, but strongly detectable in the BMZ of a skin organ culture. Our last international speaker was Dr. Michele Mignogna (Uni- versity of Naples, Italy) who presented on his 20+ years of treat- ing patients with oral pemphigus and pemphigoid in Naples. Dr. Mignogna has used a blend of conventional methods and newer strategies. He talked about the differences between treating pa- tients in the United States vs. Ita- ly.

Generally, Dr. Mignogna prefers to use rituximab (and IVIg in severe cases) where they can only be used in medical facilities. He then men- tioned that the use of rituximab and IVIg do not require insurance com- pany approval in Italy, but the ap- proval of the hospital committee, and are no cost to patients. Our final speaker of the conference was Dr. Sergei Grando, who returned to the podium to discuss new immunosuppressive drugs for blistering diseases. Dr. Grando discussed the therapeutic ladder for PV and the treatment algorithm for pemphigoid before mov- ing on to cytotoxic drugs. He referenced a study that concluded the “most efficacious cytotoxic drug to reduce steroids was found to be azathioprine.” He mentioned that all treatments have side effects, some of which can be serious, and treatments that work rapidly have the most serious side effects. Dr. Grando discussed the current challeng- es and said that current drugs suppresses all immune responses—good and bad—result- ing in unnecessary side effects. Ideally, se- lective immunosuppressive treatments that could suppress only pathogenic responses would be developed.

This year’s Annual Meeting would not have been the success it was without the present- ers who volunteered their time. The IPPF would like to thank each and every speak- er for helping make this year’s meeting the best ever!