The following risk “fact”-ors are provided to clarify misconceptions about pemphigus and pemphigoid.

Pemphigus

• 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

*sulfur containing

Pemphigoid

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