Abstract
Background: Pemphigus vulgaris (PV) is a rare and possibly lethal autoimmune blistering disorder. PV induces flaccid blisters and erosions on the skin and mucous membranes as a result of keratinocyte dissociation inside the epidermis. Objectives: The objective of this research was to examine the correlation between the gene expression levels of interleukin-4, interleukin-21, and tumor necrosis factor-alpha and the incidence of PV, while also assessing the effects of gender and geographical location. Materials and Methods: A case-control study was conducted involving 26 clinically diagnosed PV patients and 52 healthy controls from Babylon Province, Iraq. Participants were aged 30 to 72 years. RNA was extracted from peripheral blood, and the gene expression of the target cytokines was quantified using one-step RT-qPCR with the 2^(-ΔΔCt) method. Results: The study revealed that 19 patients (73.1%) were female and 9 (26.9%) were male, with ages ranging from 30 to 72 years. Most patients lived in urban areas 16(61.5%), while fewer resided in rural areas 10(38.5%). We found notably higher dysregulation in the gene expression of both IL-4 and IL-21 among PV patients. Although TNF-α expression levels showed no significant difference, the average for cases (2.10±2.60) was still slightly higher than that of the control group (1.92±1.83). Conclusion The significant downregulation of specific interleukins suggests a complex, stage-dependent immune dysregulation in PV that may be influenced by environmental factors such as urbanization. Further large-scale, multicenter studies are warranted to fully elucidate these cytokine dynamics.