**7. Disease activity assessment**

Various scoring systems have been developed and validated for assessing pemphigus disease severity. The most widely used disease activity scoring system is the Pemphigus Disease Activity Index (PDAI). PDAI is based on the number of lesions found in the skin, scalp, and mucosa and the area of skin lesion. PDAI is an objective scoring method as it gives equal weight to the involvement of the skin and different mucosal areas and provides extra evaluation within the scalp. In addition, the fact that it consists of a single-page form provides ease of use. This score ranges from 0 to 263, moderate disease is defined by a PDAI score of 14 or less, major disease is defined by a PDAI score of 15 to 44, and extensive disease is defined by a PDAI score of 45 or higher [7, 23]. Another frequently used scoring method is ABSIS (Autoimmune Bullous Skin Disorder Intensity Score). It is evaluated between 0 and 206 according to the clinical severity of skin lesions, the number of areas involved in the oral mucosa, and the discomfort during feeding. When evaluating this score, ABSIS <17 is considered a mild disease, ABSIS 17–53 is considered a moderate disease, and ABSIS >53 is considered a severe disease. The advantages of this method are that it allows both objective and subjective evaluation and can be used in all bullous diseases [7, 23]. A third system, called the Pemphigus Vulgaris Activity Score (PVAS), takes into account the localization, morphology and severity of mucocutaneous lesions, as well as the presence of Nikolsky's sign [24].
