during the fifth and sixth decades. The primary lesion is a flaccid blister filled with clear fluid, and
originating from a normal or erythematous skin base. Since blisters are fragile, they rupture easily, producing
large, shallow, and painful erosions that heal slowly. Hence, erosions are the most common skin
manifestation of the disease. Still, mucosal lesions (usually oral) are the most common presenting
manifestation, affecting 50–70% of patients and often preceding cutaneous involvement by several months.
Since intact bullae are rare in the mouth, most patients have irregularly shaped erosions of gingival, buccal, or palatine mucosa. These are painful, slow to heal, and interfere with eating, drinking, or swallowing. Other
involved mucosae include conjunctiva, esophagus, larynx, labia, vagina, cervix, penis, urethra, and anus.