Pemphigus vulgaris is the result of one’s immune system attacking healthy cells in the skin rather than foreign invaders. It creates blisters or sores on the skin which are prone to rupturing and infection. Though it is a skin disease, it often has laryngeal manifestations, which can make it difficult to swallow or eat.
Bullus pemphigoid is different than pemphigus vulgaris in that the blisters do not rupture as easily, making infection less likely. It also may have laryngeal manifestations. It is, however, more rare than pemphigus vulgaris.
The cause of both pemphigus vulgaris and bullus pemphigoid is unknown.
Textbook chronic sore throat (1 of 4)
This man has a chronic low-grade sore throat. Note the ulcerated areas especially along the right side of the tip of the epiglottis. Surrounding mucosa also appears erythematous. This picture is classic for laryngeal pemphigoid and visual criteria for diagnosis are extremely strong.
Closer range (2 of 4)
At closer range under narrow band light, compare and contrast the ulcerated areas (U) with the inflammatory surround (I).
Four months later (3 of 4)
Four months later, the patient has since developed “blisters” on his back. Biopsy at that site was consistent with pemphigoid. Compare this to photo 1 to appreciate that the pattern of the lesions has changed slightly as is typical for pemphigoid.
Pattern at closer range (4 of 4)
At much closer range under narrow band light, the stippled “autoimmune” kind of vascular pattern is better seen.