Immunofluorescent Image of Pemphigus Vulgaris

When you look at this image, you see a hint of the miracle that is our skin.  As you know, in pemphigus vulgaris IgG attacks the intracellular attachments that hold the skin cells together, resulting in loss of adhesion of these cells.  The blisters that form are only roofed by the stratum corneum (in which the cells adhere to one another by a different mechanism than the suprabasilar keratinocytes) , and so are fairly fragile, especially so in the mucosa, because the stratum corneum is relatively nonexistent there.  What does that translate to in clinical terms?  Thin walled, very fragile blisters that are easily burst, and erosions in the mouth, because of the lack of stratum corneum.

As a little aside, many people who have pemphigus are exacerbated by ingestion of members of the onion family;  as part of your management strategy, have them stay away from onions, garlic, leeks, shallots and the like.