About 50% of cases begin with blisters in the mouth, followed by skin blisters. Skin lesions may come and go.
The skin lesions may be described as:
They may be located:
The skin separates easily when the surface of unaffected skin is rubbed sideways with a cotton swab or finger. This is called a positive Nikolsky's sign.
A skin lesion biopsy can help confirm the diagnosis.
Baroni A, Lanza A, Cirillo N, Brunetti G, Ruocco E, Ruocco V. Vesicular and Bullous Disorders: Pemphigus. Dermatol Clin. 2007 Oct;25(4):597-603, ix.