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Apthous ulcer

Aphthous ulcers are discrete, self-limited ulcers, unlike the extensive, persistent, and fragile erosions that characterize the oral onset of pemphigus.

Behcet's disease

The ulcers of Behcet's are "punched-out" and recurrent but not typically as widespread and erosive as in pemphigus, and Behcet's is defined by other systemic features (genital ulcers, uveitis).

Bullous pemphigoid

BP is distinguished by its large, tense, intact bullae on the skin, whereas pemphigus has superficial, flaccid bullae that rupture very easily, leaving widespread erosions.

Cytotoxic drugs

Mucositis from chemotherapy is an acute event related to drug administration, not a chronic autoimmune disease.

Fogo selvagem

This is an endemic form of pemphigus foliaceus in Brazil, which is more superficial and crusted, lacking the deep oral erosions of pemphigus vulgaris.

Generalized bullous fixed drug eruption

This is an acute, widespread blistering reaction to a drug, which resolves on cessation, unlike the chronic autoimmune nature of pemphigus.

IgA pemphigus

This is a pustular or vesicular disease, often with an annular pattern, and is defined by IgA deposits on immunofluorescence, not the IgG seen in pemphigus vulgaris.

Mucous membrane pemphigoid

MMP is a subepidermal blistering disease that causes scarring, particularly of the eyes and oral cavity, whereas pemphigus is an intraepidermal disease that typically does not scar.

Paraneoplastic pemphigus

This is a severe variant associated with an underlying malignancy (often lymphoma), distinguished by its severe, intractable stomatitis and polymorphic skin lesions.

Pemphigoid gestationis

This is a blistering disease of pregnancy, a specific clinical context not required for pemphigus.

Pemphigus erythematosus

This is an overlap syndrome of pemphigus and lupus, distinguished by having features of both, such as a malar rash and positive ANA, along with pemphigus antibodies.

Pemphigus foliaceus

This is a more superficial form of pemphigus, causing crusted, scaly erosions on the skin ("cornflake scale") and characteristically sparing the mucous membranes.

Pemphigus vegetans

This is a variant of pemphigus vulgaris, distinguished by the development of hypertrophic, vegetative, malodorous plaques in intertriginous areas.

Stevens-Johnson syndrome

SJS is an acute, severe reaction to a drug, characterized by targetoid lesions and widespread mucosal sloughing, a different clinical picture than chronic autoimmune pemphigus.

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