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Pemphigus  

Pemphigus is a group of diseases characterised by intraepithelial blistering, usually affecting the skin and sometimes the mucous membranes. Oral lesions are commonly seen in pemphigus vulgaris and paraneoplastic pemphigus. In most cases oral lesions precede cutaneous lesions and present as blisters which quickly rupture, leaving painful haemorrhagic erosions and ulcers with sloughing. These can be seen in any part of the oral cavity and may also affect other areas like conjunctiva, larynx or oesophagus. This is considered an auto-immune disease. There is no gender predilection. Remission is common after an unpredictable period or time; however, sometimes the lesions are very aggressive and may even be fatal. Mild cases of mucosal lesions can be treated with topical steroids, though severe cases require systemic steroids. In resistant cases azathioprine or cyclophosphamide or both are used.

Image	Caption
	Figure 1: Pemphigus vulgaris. Fig. 1A: Note the bullous lesion on both hands in this 69–year-old man with pemphigus vulgaris. Fig 1B: oral cavity of the same patient with painful small ulcers with ragged edges and with white or blood tinged exudate involving both buccal mucosa.
	Figure 2: Note the numerous slough covered ulcers on the lower labial mucosa of this patient with pemphigus vulgaris.
	Figures 3: Mucosal lesions, which bleed on touch, on both buccal mucosa in this patient with pemphigus vulgaris.
	Figures 4: Pemphigus. Note the vesicles (arrow) on the right commissure, right buccal mucosa and the ventral surface of the tongue in a patient with pemphigus.
	Figure 5: Pemphigus vulgaris of the tongue.
	Figure 6: Vessicles in the neck of a patient with pemphigus vulgaris.
	Figure 7: Pemphigus vulgaris. Note the multiple shallow ulcerations covered with pseudomembrane and surrounded by erythematous halo on the left buccal mucosa.
	Figure 8: Pemphigus vulgaris. Photograph of the same patient showing multiple shallow ulcers on the upper and lower lip and tongue. Tongue is oedematous with crenations.