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Pemphigus: Signs and symptoms

What are the signs and symptoms of pemphigus?

When someone develops pemphigus, it can develop slowly, causing blisters in the same area for years.

Signs and symptoms can also show up quickly. Blisters can appear suddenly and spread. Widespread pemphigus can be life threatening. It can turn an otherwise healthy person into one who is extremely sick, incredibly tired, and in pain.

The following explains how pemphigus affects different areas of the body.


On the skin, blisters usually begin in one area. They can develop on normal-looking skin or skin that looks inflamed. Either way, the blisters soon break open and ooze fluids. They then become sores partly covered with crust.

The following pictures show what pemphigus can look like on the skin.

Pemphigus vulgaris

The blisters have burst, leaving painful sores. About 70% of people who get pemphigus have this type.

Pemphigus vulgaris blisters

Pemphigus foliaceus

This type of pemphigus affects only the skin and often develops on the face, scalp, and upper body.

Pemphigus foliaceus blisters on the skin

Drug-induced pemphigus

Some people get pemphigus after taking certain medicines. This man took penicillamine, which is the most common cause of drug-induced pemphigus.

Drug-induced pemphigus blisters

The sores are often painful, but rarely itchy. Some people say the affected skin burns.

The sores tend to heal slowly, and some never heal. When a sore heals, you may see a dark spot in its place. This is not a scar. Some people see dark spots when their skin heals. The dark spots often fade on their own, but this can take time.

Mouth and throat

Painful mouth sores are common in people who have pemphigus vulgaris, the most common type of pemphigus. About 50% to 70% of people who have pemphigus vulgaris develop mouth sores before blisters appear on their skin.

Mouth sores begin as blisters, which quickly burst causing the painful sores.

These sores can be so painful that some people stop eating solid food and use a straw to drink. If sores develop in the throat, talking can be painful.

Some people see the blisters spread from their mouth to their lips and then their skin.

Mouth sores

Most people who have pemphigus vulgaris develop mouth sores at some point.

Pemphigus vulgaris develop mouth sores


Nail problems develop in some people who have severe pemphigus. An infection may develop in the skin around the nail as shown here. Some people see their nails slowly disappear.

With treatment, most people can recover lost nails.

Nail problems

While rare, pemphigus can affect the nails and surrounding skin.

Pemphigus can affect the nails and surrounding skin

Moist tissues

Painful sores can develop in the tissue lining the inside of the eyes and nose, genitals, anus, and other areas of the body. Even the esophagus (the tube that connects the throat to the stomach) can develop blisters and sores in rare cases.

Other signs and symptoms of pemphigus

  • Pain

  • Fatigue

  • Weakness

  • Light sensitivity

  • Eye problems

If you notice blisters that suddenly appear on your skin, inside your mouth, or elsewhere, immediately make an appointment to see a board-certified dermatologist. Many skin diseases can cause blisters. An accurate diagnosis is essential.

Images 1 – 4 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 5: (J Am Acad Dermatol 2000;43:529–35.)

Amagai M. “Pemphigus.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:417-29.

Habif TP, Campbell, JL, et al. “Vesicular and bullous diseases.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Cards# 100 and 101.

Stanley JR. “Pemphigus.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 459-74.