Medicine (Baltimore) 96 (46): e8801, 2017. doi: 10.1097/MD.0000000000008801 Symptoms and Signs of Pemphigus Foliaceus The primary lesion is a flaccid vesicle or bulla, but due to the superficial location of the epidermal split, lesions tend to rupture, so intact bullae or vesicles are rarely evident on examination.