The epithelial phenotypic marker E-cad is downregulated and the myofibroblast markers α-SMA and type I collagen are upregulated in PF (Qu et al., 2015; Lacy et al., 2018), and the high expression of α-SMA is associated with a lower survival rate in patients with PF. This evidence concerns the gene ACTA1 and pemphigus foliaceus.