Diagnosis of Pemphigus vulgaris

At the beginning of every diagnosis is the questioning of the patient. This is also called anamnesis. In addition, the doctor will look at the affected parts of the body.

Blisters on the oral mucosa, on other parts of the body and a positive Nikolski’s sign can indicate pemphigus vulgaris. The Nikolski’s sign is checked to determine the tendency to blistering. The doctor tests how the blisters behave when they are pushed.

In addition, a microscopic view of the blisters or their contents can be taken. For this purpose a tissue sample is taken under local anesthesia. If the physician recognizes rounded skin cells under the microscope, a positive Tzanck test is present.

This means that the doctor sees a typical change in the skin layers under the microscope. A detection of “pemphigus antibodies” can confirm the suspected diagnosis. These can be examined in various ways.

One possibility is their presentation by a special staining method. The number of antibodies correlates with the severity of the disease. In advanced stages, the inflammation parameters in the blood count, as well as the electrolytes and serum proteins are examined more closely. During the course of the disease, regular check-ups should be performed.

Associated symptoms

The first symptoms of pemphigus vulgaris are usually not very pronounced over a long period of time. Consequently, they are often not recognized. The patients show blistering in a certain or different part of the body.

These blisters are often flabby and fragile. They are located on rather less inflamed skin. They are usually filled with a transparent liquid.

After a short time they burst open. Erosions, crusts, scars and hyperpigmentation can then develop. Often the oral mucosa is affected and can be or remain the sole site of complaints for a long time.The parts of the body where the symptoms occur particularly frequently are the scalp, the oral mucosa, mechanically stressed skin areas and the face.

These areas are also known as predilection sites. Only in the case of extensive infestation do a loss of appetite, fatigue, a feeling of illness and fever occur in addition to blistering. Pemphigus vulgaris often manifests itself on the oral mucosa.

In more than 50% of cases, the disease begins in this area. Whitish coatings and abrasions are typical. In technical jargon, the abrasions are also called erosions.

As a rule, the bursting of the blisters occurs more rapidly on the mucous membranes than on other parts of the body. The sometimes bleeding abrasions are often very painful for the patient. If pemphigus vulgaris has manifested itself on the mucous membrane, care should be taken to ensure a balanced and adequate diet. In addition to the oral mucosa, the genital mucous membranes can also be affected.