Some patients with autoimmune pemphigus (AP) are resistant to systemic glucocorticoid monotherapy, that is, are steroid-resistant. A retrospective analysis of case histories of 118 AP patients was carried out to detect the probable trigger factors promoting the manifestation of steroid resistance during the first year of therapy and showed that steroid-resistant patients could not indicate the cause of AP exacerbation 5 times more often than other patients. 

        It seems that steroid resistance of these patients was caused by genetic factors. Steroid resistance was detected in all patients with paraneoplastic pemphigus. A relationship between stress and exacerbation was detected in only steroid-resistant patients. Frequent exacerbations of AP because of insufficiently hight dose of systemic glucocorticoids (SGC) and rapid reduction of SGC dose were detected in steroid-resistant patients and in patients without steroid resistance. No significant relationships between steroid resistance and clinical manifestations of AP, location of efflorescence, and Nikolsky’s symptom were detected.


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