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This article discusses the relationship between hypogammaglobulinemia-induced skin infections and post-rituximab paradoxical flare in pemphigus. The study found that certain clinical and immunological factors, such as Pemphigus Disease Area Index (PDAI) score and anti-Dsg1 levels, were significantly associated with disease flare after rituximab infusion. The authors also mention the importance of investigating the role of infections, hypogammaglobulinemia, and other underlying factors in predicting and preventing flare-ups in pemphigus patients treated with rituximab. However, there are some points that require further clarification, such as the reasons for changes in treatment plans and the lack of reported microbial studies from lesional skin. [Extracted from the article]