The PF has been alleviated by pirfenidone through suppressed Wnt/GSK-3beta/beta-catenin and TGFβ1/Smad2/3 signaling pathways (37), and by neohesperidin through TGFβ1/Smad3 inhibition (36); whereas, multiwall carbon nanotubes has been reported to mediate macrophage activation and PF progression through induced TGF-beta/Smad signaling pathway (38). This evidence concerns the gene SMAD3 and pemphigus foliaceus.