DIF: intercellular IgG

DIF: intercellular IgG

DIF: negative

Abbreviation: DIF, direct immunofluorescence.

Abbreviation: DIF, direct immunofluorescence.


■ Pemphigus foliaceus: circulating antibodies directed against the cell surface of keratinocytes, specifically desmoglein 1


1. Payne AS, Hanawaka Y, Amagai M, Stanley JR. Desmosomes and disease: pemphigus and bullous impetigo. Curr Opin Cell Biol 2004; 16:536-543.

2. Hoque S, Hextall J, Hay R. Clinicopathological case 3: pemphigus foliaceus; bullous impetigo; subcorneal pustular dermatoses. Clin Exp Dermatol 2003; 28:465-466.

Clinical Presentation:

■ Pustules that quickly break to form honey-colored crusts.

■ Lesions may be found anywhere but most often are located on the face.


■ "Beefy red" macular erythema with surrounding satellite papules and pustules

■ Macules, papules, and pustules tend to occur in moist areas particularly the perineal, perianal, and intertrigi-nous areas


■ Pruritic scaly rash, occasionally annular ("ringworm") eruption on the trunk or extremities

■ Confluent macular erythema with serpiginous, elevated, scaly margin in intertriginous areas

■ Rarely may be pustular or bullous (Fig. 3B) Histology (Similar for All Three Entities) (Fig. 3C):

■ Subcorneal pustule containing neutrophils and a few acantholytic keratinocytes

■ Adjacent epidermis has spongiosis and exocytosis of neutrophils

■ Dermal infiltrate of lymphocytes and neutrophils AdjuvantTests:

■ Bacteria may be difficult to find, but cocci will stain with tissue Gram stain

■ Periodic acid Schiff (PAS) or methenamine silver stains highlight candida or dermatophyte organisms

Clinicopathologic Correlation:

Clinical Feature

Pathologic Feature

Fragile small pustule

Subcorneal pustule filled with

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