Pemphigus vulgaris usually starts with oral erosions or ulcers that can be mistaken for aphthous ulcers (“canker sores”). These are very painful and interfere with eating and talking. Another early sign are scalp sores. These sores are like open wounds and can be confused with a local scalp infection. Skin sores are called blisters but these are weak or flaccid and break so easily that it looks more like the skin has been scraped, red and weepy. These are called erosions of the skin and can cause pain. About one half of people with pemphigus vulgaris will go on to get blisters and sores over the skin of the body. As it is a rare disease, it is not uncommon for people to have the condition progress over a period of months to years without a diagnosis being made.
Pemphigus foliaceus is a rash that looks more scaly, like eczema, than like blisters. The face is a common site, but it can also occur on the scalp and body. The skin is very prone to infection and some times will be intolerably itchy or painful.
Paraneoplastic pemphigus (pemphigus that is caused from an underlying cancer) usually presents with very sore and eroded lips, pain and redness of the eyes and a widespread rash that has areas that blister and become sore and other areas that are itchy and hive-like.