A substantial number of PV patients shows a transition from a mucosal dominant to a mucocutaneous phenotype with skin lesions characteristic of PF as a result of epitope spreading, a process of diversification of B and/or T-cell responses from the initial dominant epitope (i.e., Dsg3) to a secondary one (i.e., Dsg1) (31). Here, DSG1 is linked to pemphigus foliaceus.