Pemphigus Vulgaris vs Bullous Pemphigoid - Comparison Table Pemphigus Vulgaris • Epidemiology: Average age 40-60 • Time course: Chronic, relapsing • Symptoms: Painful • Mucosal involvement: Common • Bullae: Flaccid, many already ruptured • Nikolsky sign: Positive • Antibodies: Autoantibodies against desmoglein 1 and 3 • Histology: Suprabasilar clefting, "row of tombstone" pattern of basal keratinocytes. • Direct Immunofluorescence: Intercellular IgG deposits • Treatment: Systemic glucocorticoids + /- nonsteroidal immunomodulator Bullous Pemphigoid: • Epidemiology: Elderly >60 • Time course: Chronic, relapsing • Symptoms: Itchy • Mucosal involvement: 10-30% • Bullae: Tense • Nikolsky sign: Negative • Antibodies: Hemidesmosomal bullous pemphigoid antigens BP 230 and BP 180 • Histology: Subepidermal clefting • Direct Immunofluorescence: Linear IgG deposits at basement membrane • Treatment: Systemic or topical glucocorticoids + /- nonsteroidal immunomodulator SCVMC Internal Medicine @SCVMCMed #Pemphigus #Vulgaris #Bullous #Pemphigoid #Comparison #diagnosis
