Pemphigoid vs Pemphigus Histology — NDEB AFK MCQ
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Correct answer: A — Subepithelial (subbasilar) cleft formation with intact basal cells on the floor of the blister
Mucous membrane pemphigoid (MMP, cicatricial pemphigoid) shows subepithelial (subbasilar) separation — the epithelium separates cleanly from the underlying connective tissue at the level of the basement membrane zone, with intact basal cells visible on the roof of the blister. In contrast, pemphigus vulgaris shows intraepithelial (suprabasilar) acantholysis with Tzanck cells (rounded, detached keratinocytes). Direct immunofluorescence in MMP shows linear IgG and C3 at the basement membrane zone.
Reference: Neville – Oral and Maxillofacial Pathology, 4th ed., 2016