Diagnosis
As part of the diagnosis of Pemphigus a skin specialist (dermatologist) conducts a physical evaluation and evaluates the appearance and distribution of the skin lesions, blisters and/or sores. A skin biopsy may be required to confirm the diagnosis. The biopsy is taken from the edge of the blister and is prepared and examined microscopically by a histopathologist who looks for an intraepidermal vesicle that is often the result of the epidermal cells breaking away. The sloughing away of the upper epidermal cells exposes the "tombstone appearance" of the bottom layer of the epidermal cells.
The presence of anti-desmoglein auto antibodies is also checked by direct immunofluorescence on the skin biopsy or, by evaluating a blood sample using the ELISA method.
A high titre of cANCA (cellular Anti Neutrophil Cytoplasmic Antibody) is another significant feature of pemphigus.
