Pemphigus Clinic


Arti Nanda (Consultant)

Eman El-Masri (Consultant)

Jihan Raji (registrar)

 Some Diseases Photos from Autoimmune Bullous Diseases (ABD) Clinic:

Pemphigus Vulgaris

Pemphigoid Gestationis

        IIF-SS-Bp (Immunoreactants at roof of the blister)

               DIF-PV (C3 in ICS)

        DIF-BP (Linear C3 at BMZ)

              Bullous Pemphigoid

Autoimmune Bullous Diseases (ABD) Clinic

As'ad Al-Hamad Dermatology Center, Kuwait

 An autoimmune bullous diseases (ABD) clinic was started from July 1993. It runs once weekly on every Tuesday and provides diagnostic and management facilities to all the patients with autoimmune bullous diseases from the catchment area as well as those referred by the Dermatologists from elsewhere in Kuwait for a specialized tertiary care. More than 200 patients with various autoimmune bullous diseases have been registered till date. The various ABDs registered with us in descending order of frequency include:

1.                  Pemphigus subsets

a.                  Pemphigus vulgaris

b.                  Pemphigus foliaceus

c.                   Pemphigus erythematosus

d.                  Pemphigus vegetans

e.                  IgA pemphigus

f.                    Pemphigus herpetiformes

g.                  Paraneoplastic pemphigus


2.                  Bullous pemphigoid

3.                  Pemphigoid gestationis

4.                  Linear IgA bullous disease

5.                  Epidermolysis bullosa acquisita

6.                  Lichen planus pemphigoides

7.                  Bullous SLE

8.                  Hailey-Hailey disease (benign familial pemphigus)


Diagnostic Facilities Available:

1.                  Skin biopsy:

a.                  H.E.

b.                  Direct immunofluorescence

2.                  Indirect immunofluorescence (IIF)

3.                  IIF with salt splitting

4.                  Desmoglein 1 and 3 ELISA

5.                  BP ELISA (for both BP antigen II and I)

6.                  ANA, ENA

7.                  Routine laboratory work-up

8.                  Other investigations relevant to the case, treatment or as indicated during the course.

 Treatments Available:

1                    Systemic steroids

2                    Azathioprine

3                    Mycophenolate mofetil

4                    IVIG

5                    Cyclophosphamide

6                    Cyclosporine

7                    Methotrexate

8                    Tetracyclines and niacinamide

9                    Dapsone

10                Rituximab

11                Acetretin

12                Systemic antibiotics

13                Topical supportive therapy:

c.                   Topical steroids

d.                  Tacrolimus

e.                  Pimecrolimus

f.                    Antiseptics/ antibiotics

14                Intralesional steroids

 CME Activities:

 1st Autoimmune Diseases Symposium: Was held in Kuwait in Collaboration with International experts. (March, 2004)

 For having more details about the observations made in this clinic over the last 16 years, kindly refer to:



1.                  Nanda A, Nanda M, Dvorak R, Al-Sabah H, AlSaleh QA. Bullous pemphigoid (BP) in an infant complicated by tuberculous meningoencephalitis. Int J Dermatol 2007; 46: 964-966.

2.                  Nanda M, Nanda A, Al-Sabah H, Dvorak R, AlSaleh QA. Paraneoplastic pemphigus (PNP) in association with B-cell lymphocytic leukaemia (BCLL) and hepatitis C infection: favorable response to intravenous immunoglobulins and prednisolone. Int J Dermatol 2007; 46: 767-769.

3.                  Nanda A, Dvorak R, Al-Sabah H, AlSaleh QA. Linear IgA bullous disease (LABD) of childhood: an experience from Kuwait. Pediatr Dermatol 2006; 23: 443-447.

4.                  Nanda A, Dvorak R, Al-Sabah H, Madda JP, Anim JT, AlSaleh QA. Association of linear IgA disease (LABD) of childhood with Crohn�s disease. Int J Dermatol 2006; 45: 1184-1186.

5.                  Nanda A, Al-Saeid K, Al-Sabah H, Dvorak R, AlSaleh QA. Clinicoepidemiological features and course of 43 cases of bullous pemphigoid (BP) from Kuwait. Clin Exp Dermatol 2006; 31: 339-342.

6.                  Nanda A, Kapoor MM, Dvorak R, Al-Sabah H, AlSaleh QA. Coexistence of pemphigus vulgaris with systemic lupus erythematosus. Int J Dermatol 2004; 43: 393-394.

7.                  Nanda A, Dvorak R, Al-Saeid K, Al-Sabah H, AlSaleh QA. Spectrum of autoimmune bullous diseases in Kuwait. Int J Dermatol 2004; 43: 876-881.

8.                  Nanda A, Al-Saeid K, Dvorak R, Al-Muzairai I, Al-Sabah H, Al-Arbash M, AlSaleh QA. Clinicoepidemiological features and HLA tissue typing in pemphigoid gestationis patients in Kuwait. Clin Exp Dermatol 2003; 28: 301-306.

9.                  AlSaleh QA, Nanda A, l-Baghli NM, Dvorak R. Pemphigus in Kuwait. Int j Dermatol 1999; 38: 351-356.