Editing Pemphigus (section)

==Diagnosis==
Pemphigus defines a group of autoimmune intraepithelial blistering diseases that are characterized by loss of normal cell-cell adhesion (acantholysis), and by the presence of pathogenic (predominantly IgG) autoantibodies reacting against epithelial adhesion molecules.<ref name=":0"/> Pemphigus is further divided in two major subtypes: pemphigus vulgaris (PV) and pemphigus foliaceus (PF). However, several other disorders such as IgA pemphigus, IgE pemphigus, pemphigus herpetiformis, drug-induced pemphigus, Senear Usher syndrome, and endemic pemphigus foliaceus exist, and are recognized by a [[dermatologist]] from the appearance and distribution of the skin lesions. It is also commonly diagnosed by specialists practicing [[otolaryngology- head and neck surgery]], periodontists, oral and maxillofacial surgeons, and [[ophthalmology|eye doctors]], as lesions can affect the eyes and mucous membranes of the oral cavity. Intraorally, it resembles the more common diseases [[lichen planus]] and [[mucous membrane pemphigoid]].<ref name="SappEversole1997">{{cite book|last1=Sapp|first1=J. Philip|last2=Eversole|first2=Lewis R.|last3=Wysocki|first3=George P.|title=Contemporary Oral and Maxillofacial Pathology|url=https://books.google.com/books?id=OvppAAAAMAAJ|year=1997|publisher=Mosby|isbn=978-0-8016-6918-7}}[http://www.sciencedirect.com/science/book/9780323017237 also here]</ref> Definitive diagnosis requires examination of a skin or mucous membrane [[biopsy]] by a [[dermatopathologist]] or oral pathologist. The skin biopsy is taken from the edge of a blister, prepared for [[histopathology]] and examined with a microscope. The pathologist looks for an intraepidermal [[Vesicle (dermatology)|vesicle]] caused by the breaking apart of epidermal cells (acantholysis). Thus, the superficial (upper) portion of the epidermis sloughs off, leaving the bottom layer of cells on the "floor" of the blister. This bottom layer of cells is said to have a "tombstone" appearance.

Definitive diagnosis also requires the demonstration of antidesmoglein autoantibodies by [[Immunofluorescence|direct immunofluorescence]] on the skin biopsy. These antibodies appear as [[IgG]] deposits along the desmosomes between epidermal cells, a pattern reminiscent of chicken wire. Antidesmoglein antibodies can also be detected in a blood sample using the [[ELISA]] technique.

=== Classification ===

Pemphigus is a group of autoimmune blistering diseases that may be classified into these types:<ref name="Fitz2">{{Fitzpatrick 6|59|559}}</ref>
:* [[Pemphigus vulgaris]]
:* [[Pemphigus vegetans]]
:*[[Pemphigus vegetans of Hallopeau]]
:*[[Pemphigus vegetans of Neumann]]
:* [[Pemphigus foliaceus]], of which there several forms:
:* [[Pemphigus erythematosus]] or [[Senear–Usher Syndrome]]
:* [[Endemic pemphigus foliaceus]] with its three variants, [[Fogo Selvagem]], the new variant endemic pemphigus Foliaeus and [[Tunisian endemic pemphigus foliaceus]]
:* [[Paraneoplastic pemphigus]]
:* [[IgA pemphigus]], of which there several forms:
:* [[Subcorneal pustular dermatosis]]
:* [[Intraepidermal neutrophilic IgA dermatosis]]
:*[[Drug induced pemphigus]]