dermatologic disorders
Pemphigus Vulgaris
Symptoms and Signs of Pemphigus Vulgaris
Flaccid bullae, which are the primary lesions of pemphigus vulgaris, cause widespread and painful skin, oral, and other mucosal erosions. About half of patients have only oral erosions, which rupture and remain as chronic, painful lesions for variable periods. Often, oral lesions precede skin involvement. Dysphagia and poor oral intake are common because lesions also may occur in the upper esophagus. Cutaneous bullae typically arise in normal-appearing skin, rupture, and leave a raw area with crusting. Itching is usually absent. Erosions often become infected. If large portions of the body are affected, fluid and electrolyte loss may be significant. A rare variant called pemphigus vegetans occurs primarily in intertriginous areas and oral mucosa with vegetating cauliflower-like plaques. This image shows generalized flaccid, ruptured bullae with surrounding erythema characteristic of pemphigus vulgaris. Image courtesy of Daniel M. Peraza, MD. The primary lesions of pemphigus vulgaris are flaccid bullae. Image provided by Thomas Habif, MD. In pemphigus vulgaris, painful erosions on the skin and mucosa are common. Image provided by Thomas Habif, MD. Pemphigus lesions typically appear first in the mouth, where they rupture and remain as chronic, painful erosions for variable periods. Oral lesions often precede cutaneous lesions. Image provided by Thomas Habif, MD. This image shows erosions and fungating vegetating plaques in the axilla resulting from pemphigus vegetans. Image courtesy of Karen McKoy, MD. 