Pemphigus Vulgaris vs Bullous Pemphigoid
Pemphigus Vulgaris and Bullous Pemphigoid are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Pemphigus Vulgaris vs Bullous Pemphigoid at a glance
- Pemphigus Vulgaris: Autoimmune intraepidermal blistering disease with flaccid bullae and painful mucosal erosions.
- Bullous Pemphigoid: Most common autoimmune subepidermal blistering disease of the elderly; tense bullae on an urticarial base.
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Side-by-side comparison
| Feature | Pemphigus Vulgaris | Bullous Pemphigoid |
|---|---|---|
| At a glance | Autoimmune intraepidermal blistering disease with flaccid bullae and painful mucosal erosions. | Most common autoimmune subepidermal blistering disease of the elderly; tense bullae on an urticarial base. |
| Classic presentation | Painful oral erosions preceding flaccid cutaneous bullae in a middle-aged adult; positive Nikolsky.; Painful, persistent oral erosions (often the presenting… | Severe pruritus and tense bullae on an urticarial base in an elderly patient.; Severe generalized pruritus, often weeks to months before blisters appear… |
| Workup / key labs | Diagnosis requires clinical findings plus histology and immunofluorescence. Lesional biopsy: suprabasal acantholysis with 'tombstone' row of basal cells.… | Diagnosis requires clinical features plus histopathology and immunofluorescence. Lesional biopsy: subepidermal blister with eosinophil-rich dermal infiltrate.… |
| Imaging | No routine imaging required; Esophagogastroduodenoscopy if dysphagia or odynophagia suggests esophageal involvement; Chest imaging and age-appropriate cancer… | No routine imaging; tailor to comorbid evaluation; Consider age-appropriate malignancy screening if atypical presentation, but routine paraneoplastic workup… |
| First-line treatment | Systemic corticosteroid: prednisone 1 mg/kg/day, methylprednisolone IV for severe disease; taper slowly over months; Rituximab (anti-CD20) — now first-line… | Localized or mild disease: superpotent topical corticosteroid — clobetasol propionate 0.05% applied to the entire body 30-40 g/day (per Joly NEJM 2002 trial… |
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