The familial feature of Tunisian endemic pemphigus foliaceus

Conflicts of interest: none declared. Sir, Tunisian pemphigus foliaceus (PF) presents particular epidemiological features: the exclusive occurrence in younger women from southern areas and the absence of familial cases.1 However, the recent observation of PF in two sisters2 living in the area of endemic PF in southern Tunisia might indicate a familial clustering similar to that observed in fogo selvagem.3 A retrospective analysis of all PF records from the dermatological department of Hedi Chaker Hospital in Sfax (south Tunisia) since 1982 was performed. Firstly, we classified patients by regions and/or by family name. Then, each patient was asked about the existence of other members of their family with a dermatological problem. Thereafter this cross‐examination was oriented towards a blistering skin disease. To confirm this familial aggregation, we carried out in situ visits to families for further exploration. Data on 32 Tunisian families including 40 affected members with PF and 203 healthy related subjects were collected. Our study identified, in addition to the first family, another six PF families (Fig. 1) all living in the farming regions of the Tunisian south. To our knowledge, this study shows for the first time a significant number of PF families in Tunisia in which multiple genetically related individuals are affected. This familial aggregation provides a sound argument for similarities to Brazilian endemic PF and indicates the existence of two forms of PF in Tunisia: a sporadic form and a familial form.