Pemphi-What?

Today in morning report we heard about a patient with probable bullous pemphigoid. The pemphigoid/pemphigus question is a favourite on exams, and it can be a little confusing remembering the differences.

Here is a system to remember the characteristics of these two autoimmune skin conditions:

Pemphigus = Serious (thank you Grace for this trick!)

Pemphigus vulgaris is more serious because:
- loss of cohesion between cells leads to acantholysis, with flaccid, easily shearable bullae (and + Nikolsky sign)-> this leads to more denuded skin and thus more infections
- involves mucous membranes

Bullous pemphigoid= tense bullae (don't always break)- see pic below

- antibodies are to basement membrane, cells can still stick together
- usually seen in the elderly

- mucosal involvement less common

Definitive diagnosis of the two conditions relies on direct immunoflorescence microscopy of a biopsy sample to see where antibodies are located (epidermal basement membrane versus cell surface).


See you tomorrow!