Where do lesions associated with pemphigus vulgaris typically start?

Lesions associated with pemphigus vulgaris typically start on the oral mucosa, which is a hallmark feature of the disease. Pemphigus vulgaris is an autoimmune blistering disorder characterized by the formation of painful blisters and erosions primarily on the mucous membranes and skin. In many cases, the disease presents initially in the mouth, where individuals may experience painful ulcerations that can lead to difficulties in eating and swallowing.

The oral mucosa is particularly susceptible due to its thinner epithelial layer and the presence of desmoglein, the protein targeted by autoantibodies in pemphigus vulgaris. This early involvement of the oral mucosa is crucial for diagnosis, as the lesions can be more subtle than those seen on the skin and may not be recognized immediately.

In contrast, while lesions can eventually spread to other areas such as the scalp, trunk, or feet, these locations are less common as initial sites of involvement. Understanding this aspect of pemphigus vulgaris aids clinicians in making an early diagnosis and starting appropriate management for patients.