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Risk Fact-ors

The following riskfact”-ors are provided to clarify misconceptions about pemphigus and pemphigoid.


  • Activities: none established as a risk
  • Pesticides: none known
  • Malignancy: For paraneoplastic pemphigus only: seen in patients with concurrent neoplasia, most often: non-Hodgkins Lymphoma, Chronic Lymphocytic Leukemia, and Castleman’s disease (m). Others include adenocarcinoma (pancreas and colon most common; also breast, prostate); hepatocellular carcinoma, squamous cell carcinoma, thymoma, Waldenstroms macoglobulinemia and others.
  • Drugs (see Table below)
  • Infection: unknown / not reported
  • Foods: no known foods are causally related.
    • Nobody should avoid these foods, but consideration can be given on a case by case basis, as some patients report exacerbation of disease by certain food groups containing one or more of four ingredients: thiol, isothiocyanates, phenols or tannins.
    • Thiols: garlic and other members of the Allium group which contain plants such as onion, shallot, chive and leek.
    • Isothiocyanates (mustard oils): are found in 3200 species of plants including mustard, horseradish, winter cress, turnip, broccoli, radish, cabbage, brussel sprouts and cauliflower. Capers. Synthetic oil of mustard.
    • Phenols: Urushiol can cause contact dermatitis and is most notably found in poison ivy, poison oak and poison sumac which are related to mango, pistachio and cashew. The artificial sweetener aspartame is phenolic and common in many food additives. Phenol is in cinnamon and cinnamic acid, and pinene. It is in tomatoes, potatoes, mangos and bananas and milk and milk products produced when cows consume phenol laced feed such as cottonseed.
    • Tannins: Common sources of tannin are kola nuts, tea, coffee, raspberry, cherry, cranberry, blackberry, avocado, banana, apple, mango, pear, eggplant and grape skins, coffee and cocoa seeds, ginger, ginseng, garlic, rosemary, arrowroot,.
  • Stress: no known relationship. However, many patients report that stress (physical, physiological and psychological) exacerbates the disease.


Table 3:  Drugs associated with these conditions
Drugs associated with pemphigus vulgaris (n) Drugs associated with drug-induced bullous pemphigoid (n)
Captopril *, Enalapril, Cilazapril, Ramipril Ampicillin
Cephalosporins – cefadoxil and cephamandole, ceftazidime, ceftriaxone, cefuroxime, cephalexin Captopril*, Enalapril
Gold sodium thiomalate * Chloroquine
Interleukin Furosemide
Levodopa Penicillamine*
NSAIDs Penicillinsamoxil, ampicillin, penicillin, benyzylpenicllin
Penicillamine * Sulfapyridine
Penicillins – amoxil, ampicillin, pencillin, benyzylpenicllin Sulfasalazine
Phenobarbital PUVA: Psoralen with Ultraviolet A
Pyritinol *  
Quinolones – nalidixic acid, lomafloxacin  
Thioprine *  

*sulfur containing


  • Age: increasing incidence with age.
  • Correlations between BP flare in disease activity and recurrence of underlying cancer suggest such an association in individual patients.

Myth and Lore

Myths associated with pemphigus and MMP

  • “they are old person’s diseases.” Mean age for PV is 40-60, for MMP is 40+.
  • “whether you receive treatment or not, these diseases are fatal.” (wrong)
  • “enhancing the immune system will cure pemphigus”(wrong)
  • “pemphigus and pemphigoid are curable diseases” (wrong – but long term remissions are seen; see later)
  • “alternative medicines will cure pemphigus” (not demonstrated)