Pemphigus

Painful mouth erosions that do not heal, followed by fragile blisters that rupture with minor friction, should raise concern for pemphigus. This is not primarily a pressure-injury or vascular-wound disorder. It is an autoimmune disease in which antibodies disrupt the connections between keratinocytes, so the epidermis separates within its own layers. The resulting open erosions can involve skin and mucous membranes, allowing infection, fluid loss, nutritional decline, and severe pain to become more urgent than the appearance of any single blister. The practical nurse recognizes the pattern, protects the skin, assesses hydration and mucosal function, and reports changes promptly while following state-specific scope rules, facility policy, and the prescribed plan of care.