Diagnosing Pemphigus foliaceus: a retrospective analysis of clinical, histological and immunological criteria

Dermatology. 2001;203(4):289-93. doi: 10.1159/000051774.


Background: Clinical, histological and immunological criteria distinguish pemphigus foliaceus (PF) from pemphigus vulgaris (PV), but whether and how often they are concordant in the same patient is unknown.

Methods: Seven clinical records were selected from two hospital settings for having a diagnosis of PF and the initial serum and histopathological specimens still available. Controls were 8 PV records selected in the same way. Histopathological slides were re-evaluated. Stored sera were studied by indirect immunofluorescence (IIF), Western blot and ELISA.

Results: Acantholysis was superficial in all PF patients and deep in all PV patients. Mucosal lesions were not exclusive of PV. IIF was positive in 43% of PF patients. Western blot revealed desmoglein 1 in 86% of PF patients and in 25% of PV. ELISA revealed anti-desmoglein-1 antibodies in up to 71% of PF and in 62% of PV patients, in 1 failing to detect anti-desmoglein-3 antibodies.

Conclusions: Histopathology remains the most reliable criterion for diagnosing PF. Western blot and ELISA, especially in combination, may be only of confirmatory value.

MeSH terms

  • Acantholysis
  • Adult
  • Aged
  • Blotting, Western
  • Cadherins / analysis*
  • Desmoglein 1
  • Desmoglein 3
  • Diagnosis, Differential
  • Eosinophils
  • Female
  • Fluorescent Antibody Technique, Indirect
  • Humans
  • Male
  • Middle Aged
  • Pemphigus / diagnosis*
  • Pemphigus / immunology
  • Pemphigus / pathology
  • Retrospective Studies


  • Cadherins
  • DSG3 protein, human
  • Desmoglein 1
  • Desmoglein 3