The Difference between Pemphigus and Pemphigoid

Defining

Characteristics

Pemphigus

Pemphigoid

Types

• Pemphigus foliaceus
• Pemphigus vulgaris
• Paraneoplastic pemphigus
• IgA pemphigus

Sub-type

• Integumentary system condition (hair skin, nails)

• Gestational Pemphigoid or Herpes gestationis
• Bullous Pemphigoid
• Mucous membrane Pemphigoid or Cicatricial

Blister location

• Start with a blister in the mouth (intraoral) and can extend to the throat.
• Superficial intraepidermal.
• Mucous membranes of the genitals or perineum.
• Sores on mucosa of the mouth, lips and esophagus.
• Later stage on chest and back and face.
• Lung involvement bronchiolitis, but less frequent (irreversible).

• Subepidermal
• No cutaneous involvement.

Blister Characteristics

• Not itchy, but painful.
• Sores are painful (pemphigous pain).
• Very fragile.
• Infection risk is high.

• Bullae are intact.
• Less serious because bullae often don’t rupture.
• Infection is less.

Autoimmune antibody activities

Features acantholysis

• Does not feature acantholysis

• Auto antibodies lie against the basement of the epidermal membrane (not on epidermal junctions).

Prevalence

The condition can occur at any age, but is more often in middle age (30-60 years old)

• In women
• People 60 years old

Treatment and Management

• Early and prompt intervention prevents the disease from becoming more resistant to treatment.
• Treatment is similar for severe burns.
• Prednisone
• Oral steroids in high dosages

may cause intestinal perforations.

• Gastrointestinal system monitoring is vital.
• Oozing sores may come in contact with bed linens and clothes. Use of talcum powder may be helpful.
• Topical steroids (high-potency corticosteroids) for mild cases.
• Severe side effects require close monitoring.
• Intravenous gamma globulin for severe pemphigus is very expensive.
• Plasmaparesis for rebound pemphigus where more auto antibodies increases in numbers aims to reduce circulating antibodies.
• The effect is immediate and is safer.

• Drug of choice is corticosteroid for its potent anti-inflammatory effect.
• Steroids can cause immune suppression so it is recommended to  use adjuvant drugs
• Dosages of these drugs are titrated when the infection is controlled
• The 3 Distinct phases of immunobullos diseases treatment.

• Control high dosage of therapy targeting to suppress the disease activity and control of further occurrence of new lesions.
• Consolidation continued drug treatment of constant dosage until all lesions totally disappear.
• Maintenance is tapering off medications gradually once most lesions are controlled and totally healed. This is done to reduce risk of side effects