Cell-mediated immunity in patients with 'pemphigus vulgaris' before, during and after prolonged treatment with steroids

A study was made of the number of T lymphocytes and their functional activity in 16 patients with pemphigus vulgaris, 5 with involvement of the mucosa, 3 with involvement of the skin and 8 with involvement of both; 2 patients had been suffering from the disease for 7 years, one for one year and the remainder for one to 6 months prior to this investigation. Patients were tested prior to institution of treatment, while receiving initially high doses of steroids and subsequently on maintenance doses. T lymphocyte number was determined by the E rosette technique and their functional activity by a local xenogeneic graft-versus-host reaction (GVHR) developed in our laboratories. Prior to therapy, 50% of the patients showed impairment in T cell function, with no improvement during intensive steroid therapy; subsequently, when the disease was under control, there was a clear tendency for function to return to normal. There was no correlation between duration of the disease and immune competence but there appeared to be a partial correlation between the latter and the degree of involvement. Our study indicates that long-term steroid therapy not only benefits the clinical condition of the patient but is associated with an improvement in the immunological status.