We do not publish a staging system for blistering disease
There is no validated Ayurvedic severity scale for pemphigus or pemphigoid. None exists.
If you find a clinic publishing an "Ayurvedic staging system" for a blistering disease — numbered tiers, a tidy diagram, a phase name for each — it was invented for the website. Inventing a severity score for a disease that can kill people is not a marketing liberty. It is a fabrication, and we will not do it.
What we use instead is the information already on your clinic letter and your laboratory report — the same four things your dermatologist uses, because they are the four that actually predict what happens to you.
1. Which disease you actually have
The label is not a formality. It changes everything downstream.
- Pemphigus — the split is inside the epidermis. Flaccid blisters that rupture immediately, raw erosions, Nikolsky sign positive. Pemphigus vulgaris (anti-desmoglein 3, often later with anti-desmoglein 1) usually involves mucosa. Pemphigus foliaceus (anti-desmoglein 1) is superficial, crusted, and spares the mouth.
- Pemphigoid — the split is beneath the epidermis (anti-BP180, anti-BP230). Tense blisters that persist, usually in elderly patients, usually preceded by months of itch, and usually non-scarring.
- Mucous membrane (cicatricial) pemphigoid — the exception that scars. Eyes and mouth. Ocular involvement threatens sight and is an emergency.
- Pemphigoid gestationis — pregnancy-associated. Obstetric and dermatological care together, always.
- EB acquisita — autoimmune, against type VII collagen. Often more treatment-resistant than the others, in conventional care as well as ours, and your expectations should be set accordingly.
- Inherited epidermolysis bullosa — a genetic mutation. Not autoimmune. Not reversible by any treatment, ever. It does not belong in this classification at all, and no protocol — ours included — changes it.
2. Mucosal involvement — the biggest single determinant
Mouth, throat, oesophagus, nose, genitals, eyes.
Mucosal disease is what moves a patient from "unpleasant" to "dangerous". It drives how aggressively your dermatologist has to treat. It threatens your nutrition, because eating stops being possible. It can threaten your airway. And in mucous membrane pemphigoid it can threaten your sight.
If your mouth is involved, you are not a mild case, whatever your skin looks like. Any eye symptom needs urgent ophthalmology — not a note in the next appointment letter.
3. Extent — how much of you is involved
No score. Just the facts your dermatologist records, and that you can record too:
- How many NEW blisters or erosions appeared this week? Not the total — the new ones. This is the number that moves first, in both directions.
- How many erosions are open now, and how long has the oldest been open?
- How many regions are involved — scalp, face, chest, back, abdomen, arms, legs, groin?
- Is any single raw area larger than the palm of your hand?
- Are erosions closing, holding, or enlarging?
4. Antibody titre — the number that tracks activity
Anti-desmoglein 1 and anti-desmoglein 3 for pemphigus; anti-BP180 for pemphigoid. Measured by ELISA, on blood.
These titres broadly track disease activity, and a rising titre can precede a clinical relapse — which makes this the most objective number in your file, and the one worth arguing to have repeated.
Two honest caveats. Titres are a guide, not a verdict: anti-desmoglein 3 can remain detectable in someone who is clinically quiet, and the correlation is not perfect in every patient. And direct immunofluorescence on a biopsy is what makes the diagnosis; ELISA is what follows it over time. They are different tests answering different questions, and one does not substitute for the other.
Ask your dermatologist whether they intend to repeat the ELISA, and how often. If the answer is yes, you have a real yardstick — and so do we.
The validated scores exist, and they belong to your dermatologist
PDAI and ABSIS (pemphigus) and BPDAI (bullous pemphigoid) are validated instruments, used in specialist clinics and in clinical trials.
If your dermatologist uses one, that number is worth more than anything we could invent, and we would rather work from it than compete with it. We do not compute a rival score. You should be wary of anyone who does.
What we ask for before we take a case on
- The diagnosis, on letterhead
- The biopsy and direct immunofluorescence report
- ELISA values, with dates — every one you have
- Current drugs and doses: steroid dose in milligrams and how long you have been on it; rituximab dates; azathioprine, mycophenolate, dapsone
- Mucosal status — mouth, throat, eyes, genitals
- Photographs, and a new-blister count
- Itch score, sleep, weight, other conditions, and every other drug and supplement you take
What severity changes about our work
It does not change the sequence. L → I → F → E → S — Lowering Inflammatory Load, then Internal Healing and Gut Repair, then Functional Detox and Immune Balancing, then External Care applied at home, then Sustaining Remission — is the same for everyone, because the sequence is the medicine. Running Phase F before Phases L and I are stable mobilises internal load faster than the system can clear it and worsens the condition — and that is true whether your disease is mild or severe.
What severity changes is whether we should be involved at all right now.
Widespread active disease. Extensive mucosal disease. Ocular involvement. An airway symptom. Anyone who cannot eat or drink. That is a dermatologist, and quite possibly a hospital — not a courier and a protocol. We will say so, to you, rather than take the order.
Everything we do is formulation-based: oral compounds and topicals, couriered, taken at home. There is no procedure, no in-clinic therapy, and no clinic visit at any stage. It is supportive care alongside your dermatologist, it is never a reason to change a dose they have set, and we do not promise a cure.
