Bullous Pemphigus
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Not to be confused with Bullous Pemphigoid. Pemphigus is also often referred to as Pemphigus Vulgaris although technically this only refers to one particular type of pemphigus.


  •  Middle aged (40-60yrs)
  •  High prevalence in Jewish regions
  •  Lifelong condition


  • Autoimmune, epidermal blistering due to IgG  autoantibodies for keratinocyte surfaces (desmoglein)
  • Often mucosal involvement (>90%)
  • Potentially life threatening (rare) if it is paraneoplastic

Signs & Symptoms

  • <50% present with oral lesions
  • Thin roofed & flaccid blisters (superficial) that are easily ruptured
  • Uusally No Prodromal Symptoms
  • Affected skin painful put not pruritic
  • Nikolsky Sign – slight rubbing exfoliates the outermost layer of skin (not present in pemphigoid)
Pemphigus Vulgaris
Pemphigus Vulgaris. Image from Dermnet. Used in accordance with Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) license.


Acantholysis seen on biopsy (loss of cohesion between keratinocytes)
  • Oral steroids
  • Plasmapharesis in severe cases



  • British Association of Dermatologists: Dermatology, a handbook for medical students & junior doctors – bad.org.uk
  • dermnetnz.org


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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