Large Study Shows No Link Found Between Pemphigus and Psychiatric Disorders

Results from a large retrospective cohort study analyzing more than 120 million U.S. electronic health records found no increased risk of psychiatric disorders in patients with pemphigus.

"While 10–15% of dermatology patients are diagnosed with psychiatric disorders, the association between pemphigus and psychiatric disorders remains unclear due to limited large-scale evidence," the authors wrote. To address this, they conducted an analysis identifying 5,753 adult patients with pemphigus and matched them 1:1 to controls based on age, sex, ethnicity, and comorbidities. The analysis also recorded post-diagnosis incidence of a broad spectrum of psychiatric disorders (depression, anxiety, psychotic and bipolar disorders, substance use, and suicidal behaviors) using ICD-10-CM codes. The authors also conducted three sensitivity analyses were conducted to account for follow-up variability, completeness of baseline data, and long-term outcome reliability.

Ultimately, the results suggested pemphigus was not associated with a heightened incidence of psychiatric diagnoses. The researchers said the findings reinforce the need for population-level analyses to guide understanding of psychiatric risk in autoimmune dermatologic conditions.

"Our study suggests that pemphigus is not significantly associated with an increased risk of most psychiatric disorders compared to matched comparators, challenging earlier reports based on smaller or differently designed samples," the authors wrote in the paper. "These results underscore the value of large-scale, rigorously matched cohort studies in clarifying disease-psychiatric comorbidity associations. While routine psychiatric screening in pemphigus patients remains important, our study suggests it may not be necessary beyond the standard care applied to individuals with chronic illnesses."

Source: Emtenani S, et al. JID Innovations. 2025. Doi:10.1016/j.xjidi.2025.100432