Risk Factors Associated with Oral Candidiasis in Pemphigus Vulgaris Patients: Results from a Case-Control Study in India

Pemphigus vulgaris (PV) is a life-threatening chronic autoimmune mucocutaneous disorder managed by corticosteroids and other immunosuppressive agents. Oral candidiasis (OC) is the most common opportunistic infection in PV. This study aimed to identify the risk factors associated with OC in PV patients. This case-control study included adult cases with PV and healthy controls. Cases with a history of antifungals within the last 2 weeks were excluded. Potential risk factors based on demographics, clinical activity, and laboratory markers including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were documented. Seventy-four adult PV cases and healthy controls were included over a period of 18 months. A total of 59.4% (n = 44) of the cases were diagnosed with OC, whereas oral colonization with Candida was present in 8.1% (n = 6) of the controls. Females had 2.7 times higher odds of developing OC than males (P-value = 0.046). Cases with a history of prior topical steroid use had 2.5 times higher odds of developing OC (P-value <0.0001). Cases with a history of prior systemic antibiotic use had 1.8 times higher odds of developing OC (P-value <0.0001). Mean ± SD of NLR and PLR in patients with OC were significantly higher than in cases without OC (P-value <0.0001). OC was not associated with diabetes, oral steroids, or immunosuppressant use in PV in our study. In PV, female gender, prior topical steroid, and systemic antibiotic usage are significant risk factors for the development of OC. NLR and PLR are important laboratory markers that indicate increased predisposition to OC in PV.