Pemphigus vs Pemphigoid — ORE Part 1 MCQ
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Correct answer: D — Suprabasal acantholysis rather than subepithelial separation
Explanation lettering: B = shown as A · D = shown as B · A = shown as D
A is correct. Pemphigus vulgaris is an intraepithelial blistering disorder: autoantibody-mediated loss of keratinocyte adhesion produces acantholysis, classically with a suprabasal cleft. Mucous membrane pemphigoid is a subepithelial blistering disorder, with separation at the basement membrane zone. This level of split is the key routine histological discriminator, although direct immunofluorescence is normally required to support a definitive diagnosis. Granulomas and keratin pearls indicate different pathological processes. A neutrophilic infiltrate may occur in inflammatory blistering disease but does not reliably distinguish these two entities. Parakeratinisation is not the defining lesion in either condition.
Reference: Scully C, et al. Autoimmune aspects of pemphigus vulgaris and mucosal pemphigoid. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1996. https://pubmed.ncbi.nlm.nih.gov/8934925/