Pemphigus

Under this name a number of widely varying diseases have been described, and one of the earlier writers mentions upward of a hundred varieties of the affection. We will confine the name to a single disease, embracing but two varieties - namely, pemphigus vulgaris and pemphigus joliaceus.

In childhood two forms are observed; pemphigus acutus neonatorum, appearing during the first two weeks. The whole body is covered with bullae, some of the size of a hazel nut, and its course usually benign. A second form stands in close relationship to acute exanthemata.

In general pemphigus is characterized as regards eruption by the appearance of little separate blebs, usually grouped in threes or fours, seated upon slightly inflamed bases, which are quickly covered over by the enlarged bullae. These blebs may attain a size varying between that of a pea and a hen's egg. They are distended with fluid, which is at first very transparent, but soon becomes milky. The fluid may be quickly reabsorbed, or the blebs or bullae simply shrivel, the
distended globe becoming flaccid. Very often the blebs burst in a few days, and then the contained fluid dries into crusts of lamellar aspect, beneath which is very slight ulceration. The contents are sometimes sanguinolent. The bullae generally occur in successive crops; they develop in the course of a few hours; their outline is generally round or oval; they may be confluent, but are usually distinct. Now and then a species of false membrane is contained in the bullae. The reaction of the fluid is generally alkaline, but with the turbidity comes acidity. The local symptoms are, slight itching and smarting at the outset, and more or less soreness. The healing process in pemphigus is sometimes tardy, a thin ichor being secreted by the surface originally blebbed, and so a quasi-impetiginous crust is often produced. In rare cases, in cachectic subjects, sloughing may occur. The disease attacks all parts of the body - but rarely the head, the palms of the hands, or the soles of the feet. Sometimes the mucous surfaces - for example, the intestines, vagina, etc., are the seat of bullae in pemphigus.