At a glance: Pemphigus versus pemphigoid

Pemphigus
Discriminatory signs

  • Affects middle-aged patients.
  • Blisters over scalp, face, back and chest.
  • Oral lesions occur in 50 per cent of patients.
  • The blisters break down readily.
  • Erosions heal slowly.
  • Nikolsky’s sign — rubbing unaffected skin — produces superficial erosions.

Management

  • Biopsy for histopathology.
  • High-dose steroids, 60–120mg prednisolone daily, or immunosuppressive agents such as azathioprine.
  • Metabolic and nursing management is essential. Erosions can cause loss of proteins and fluid, and a risk of secondary infection.

Pemphigoid
Discriminatory signs

  • Affects patients over 60 years.
  • Limb, trunk and flexures are usually affected.
  • Oral lesions occur in 30 per cent of patients.
  • Large, tense, dome-shaped blisters.
  • Healing is rapid.
  • Scarring is unusual.

Management

  • Biopsy for histopathology.
  • Moderate doses of oral steroids are given.
  • There is usually a rapid response to treatment.
  • Low doses of steroids may be required for maintenance therapy.

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