Since disease activity and serum autoantibody titers (index values) are considered parallel, they evaluate response to treatment and disease activity.[2–5] However, it has been reported that anti-Dsg autoantibodies may remain at detectable levels in serum analyses in 17% to 46% of patients in remission without active pemphigus lesions.[6,7] The fact that not all anti-Dsg antibodies are pathogenic explains this situation.[8] Therefore, serum anti-Dsg levels may be misleading when evaluating disease activity. This evidence concerns the gene DSG1 and pemphigus.