In pemphigus vulgaris, the most common form of pemphigus, there are IgG antibodies that bind to the cell surfaces of epidermis of the skin as well as the epithelium lining mucosal surfaces such as the mouth. Half of the patients also develop blisters or erosions of the skin, often in the head and neck area.
Diagnosis is made by biopsying the skin or oral mucosa.
The biopsy specimens show deposition of antibodies on the cell surfaces of the epidermis or epithelium by using specialized immunofluorescence techniques performed in our Dermatoimmunology Laboratory. Our laboratory also uses immunofluorescence techniques to detect antibodies in the blood. The titer of these antibodies may be helpful in evaluating the severity of the disease as well as disease course and response to therapy. In severe cases, a patient may be admitted and undergo plasmapheresis, in which the patient's serum is removed and replaced with serum that does not contain the causative antibodies is performed. It may take several months for the oral ulcers and blisters of pemphigus vulgaris to disappear after treatment has started, as circulating antibodies remain in the blood for weeks to months.