Pathology · single question

How can Pemphigus Vulgaris (PV) be clinically distinguished from Mucous Membrane Pemphigoid (MMP)?

PV preferentially affects the attached gingiva; MMP affects the buccal mucosa primarily
PV rarely scars; MMP frequently causes scarring and can cause conjunctival/esophageal involvement
MMP responds better to corticosteroids than PV
PV causes subepithelial blistering; MMP causes intraepithelial acantholysis

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Correct answer: B. PV rarely scars; MMP frequently causes scarring and can cause conjunctival/esophageal involvement

A. Both PV and MMP can affect the gingiva (desquamative gingivitis pattern). MMP has a higher predilection for the gingiva, but this is not a reliable clinical distinguishing feature.
B. CORRECT. MMP is a subepithelial autoimmune blistering disease that frequently causes SCARRING, especially of the conjunctiva (symblepharon → blindness risk), esophagus, and larynx. PV is an intraepithelial disease that heals WITHOUT SCARRING (acantholysis spares the basement membrane). Also: MMP → subepithelial blistering (deeper split) → scarring; PV → intraepithelial split (above basal cell layer) → no scarring.
C. Both PV and MMP respond to corticosteroids. PV often requires systemic corticosteroids + immunosuppressants (rituximab) more aggressively than MMP.
D. This is the OPPOSITE. PV causes INTRAEPITHELIAL (suprabasilar) acantholysis; MMP causes SUBEPITHELIAL blistering. Not the other way around.

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