Dermatologists, with their critical and orderly minds, are ill at ease with a muddle. The classification of the chronic bullous disorders began to appeal to them only when the great controversies of the past seemed to have been settled. Once pemphigoid had been separated from pemphigus and from dermatitis herpetiformis, the subject looked simple, and the tangle of the earlier classifications and papers could safely be ignored. Since then, there has been a torrent of publications on pemphigoid, but most have dealt only with its technical aspects—histochemistry, immunology, and the like—whereas the flow of papers on the clinical side has remained sluggish. The large series of former generations, flawed though they were by diagnostic uncertainties, have not been replaced by enough new ones to make it easy to detect trends in modern mortality under modern conditions. In addition, small clouds are forming again over the classification of this difficult disorder. An ideal series should be both large and “pure”; but even the most recent may have contained examples of conditions such as linear IgA disease, 1 which have been recognized only since their publication. Missed cases of epidermolysis bullosa acquisita may have made up as much as 10% of some series, 2 and there are hints that the seropositive and seronegative types of pemphigoid should be considered separately. 3 On the other side of the coin, some of the recently described presentations of pemphigoid (pemphigoid vegetans, 4 erythrodermic pemphigoid, 5 pemphigoid nodularis, 6 and seborrheic pemphigoid 7) may not have been detected. Patients with pre-pemphigoid, 8 in the itchy prodromal stage of the disease, 9 or with localized pemphigoid 10 may also have been left out, although this may not affect a discussion limited to mortality. Few will have died during these early stages of the disease, and, for the same reason, mortality from the cicatrical variant of pemphigoid will not be considered here either. There are other problems, too. Most clinical papers on pemphigoid have focused on its course or on its treatment, and not on how patients die from it. Details of such deaths are usually given briefly and in passing, and are presented in a way that is not acceptable to an epidemiologist. Bald statements, like “The mortality of our series was 29%,” are not enough. Some patients will have been followed up only for a short time; others, for much longer. The figures have to be tied to a fixed point, the start either of the disease or of systemic treatment, and expressed as the proportion dying per unit of time thereafter. Data calculated on this basis will gain greatly from comparison with that obtained from matched controls: indeed, only in this way can the extra risk to life from pemphigoid and its treatment be estimated. Journal editors should now insist upon these points. Well-documented and controlled series exist for other conditions, such as rheumatoid arthritis, 11 but not for pemphigoid. A large, prospective, multicenter study is long overdue.