Diagnosis is based on three measures:

1. Clinical features - oral ulcers, flaccid blisters or erosions or scale

2. Histological features - acantholysis with loss of coherence between epidermal cells; upward growth of papillae lined by a single layer of epidermal cells

3. Direct and indirect immunofluorescence -detection of autoantibodies either in a biopsy specimen (direct) or in the patient's serum (indirect). The enzyme-linked immunosorbent assay (ELISA) is a new diagnostic modality that may prove to be effective for diagnosis as well as functioning as a prognostic indicator.

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