Pemphigus foliaceus

# Overview
Pemphigus foliaceus is an autoimmune blistering disease of the skin with characteristic lesions that are scaly, crusted erosions, often on an erythematous base.  Mucosal involvement is absent even with widespread disease.:423
If there is an autoimmune IgG buildup in the epidermis, then nearly almost all of the antibodies are aimed against desmoglein 1. The effect of the antibodies and the immunological pathway is most likely either of three mechanisms:
- Steric hindrance of the desmoglein 1: The antibody caps off the site for intracellular binding to another keratinocyte.
- Activation of an endocytic pathway: The antibody activates a pathway which causes an internalization of desmoglein 1, which in turn causes a loss of adhesion.
- Disruption of function: In this case, the antibody blocks the desmoglein 1 from being formed into a desmosome. This in turn causes a loss of adhesion with acantholysis as a result.

# Distribution
Pemphigus is endemic in the rural areas of Brazil, especially along inland riverbeds.

# History
Pierre Louis Alphee Cazenave first described the disease in 1844.

# Diagnosis

## Physical Examination

### Skin
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus-localized form. With permission from Dermatology Atlas.
- Pemphigus foliaceus-localized form. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.
- Pemphigus foliaceus. With permission from Dermatology Atlas.