Diagnostic delay in acute care settings and the economic burden of pemphigus and pemphigoid: A literature review

Document Type

Article

Publication Date

9-1-2026

Publication Title

Jaad Reviews

Abstract

Pemphigus vulgaris (PV), bullous pemphigoid, and paraneoplastic pemphigus are autoimmune blistering diseases carrying significant mortality risk and economic burden. Diagnosis is frequently delayed in acute care settings, where these conditions mimic common dermatoses such as cellulitis, aphthous stomatitis, and Stevens-Johnson syndrome/toxic epidermal necrolysis. While emergency departments appropriately triage and admit severely affected patients, definitive diagnosis is often delayed across the acute care continuum, averaging 6 to 12 months from symptom onset. These delays result in repeated visits, inappropriate therapies, and avoidable hospitalizations. Pemphigus vulgaris hospitalization costs average $14,500 per patient annually in the United States, and cellulitis misdiagnosis alone generates up to $515 million in preventable spending nationally. This review examines diagnostic delay across emergency and inpatient settings, evaluates the associated economic burden, and proposes strategies—including targeted education, teledermatology, and point-of-care diagnostics—to shorten time to diagnosis and reduce preventable costs.

First Page

173

Last Page

177

Volume

9

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