Pemphigus vulgaris involves autoantibodies against desmogleins 3 and 1, leading to which histologic change?

• A. Subepidermal blister
• B. Suprabasal acantholysis
• C. Intraepidermal edema
• D. Subcorneal blisters

Answer: (B)

Desmoglein-targeting autoantibodies in pemphigus vulgaris disrupt desmosomes, causing a loss of keratinocyte adhesion within the epidermis. The split occurs just above the basal layer, so the blister is intraepidermal and specifically suprabasal acantholysis. The basal layer remains attached to the basement membrane, creating the characteristic “tombstone” appearance of basal cells at the blister base. This suprabasal acantholysis distinguishes pemphigus vulgaris from subepidermal or subcorneal blistering conditions.