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Arch Dermatol. 2009;145(6):715-720.

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Diagnosis: Pemphigus vegetans (PV), Neumann type.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

Histologic examination showed psoriasiform acanthosis, focal epidermal hyperkeratosis, and intraepidermal microabscesses composed of neutrophils, eosinophils, and acantholytic squamous cells (Figure 3). Eosinophils and neutrophils were also seen in the dermis. Direct immunoflourescence showed linear and granular C3 at the dermal-epidermal junction with patchy weak intercellular staining. Intercellular IgG staining was seen throughout the epidermis. Indirect immunofluorescence (IIF) on monkey esophagus revealed circulating intercellular IgG antipemphigus antibodies. Findings of IIF on rat bladder epithelium were negative. Treatment with an oral prednisolone taper starting at 120 mg/d; dapsone, 100 mg/d; and acitretin, 40 mg/d, resulted in good improvement. A persistent exophytic plaque on the left axilla was resurfaced using carbon dioxide laser.

Figure appears in full text version. Figure 3.

DISCUSSION

Pemphigus vegetans is the rarest variant of pemphigus.¹ Characteristic features include flaccid bullae or pustules and hypertrophic papillated plaques on the face, skin folds, and oral mucosa. Vegetative and hypertrophic lesions arise from eroding pustules and . . . [Full Text of this Article]

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Arch Dermatol. 2009;145(6):715-720.
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