Pemphigus Foliaceus And Pemphigus Erythematosus

Synonyms: Pemphigus foliaceus: superficial pemphigus, fogo selvagem (endemic form in South America); pemphigus erythematosus: Senear-Usher syndrome.

Clinical Presentation: Pemphigus Foliaceus (Fig. 2A):

■ Recurrent shallow erosions, erythema, scaling, and crusting

■ Small flaccid blisters that rupture easily

■ Mucous membrane involvement uncommon

■ Occasionally drug induced

Pemphigus Erythematosus:

■ Circumscribed patches of erythema and crusting, that are localized to nose, cheeks, and ears, and that resemble lesions of lupus erythematosus

■ Crusting and bullae on the scalp, chest, and extremities, resembling pemphigus foliaceus

Histology (Similar for Both Diseases) (Fig. 2B):

■ Subcorneal, intragranular, or upper epidermal clefting

■ Acantholysis and dyskeratosis of keratinocytes in the granular layer

■ Superficial perivascular infiltrate of lymphocytes and occasional eosinophils

Immunofluorescence Studies:

■ Biopsy for direct immunofluorescence should be taken from epidermis immediately adjacent to a blister

■ In pemphigus foliaceus IgG deposited in intercellular spaces

■ In Pemphigus erythematosus IgG is not only deposited in intercellular spaces but also along basement membrane zone

Staphylococcal Scalded Skin Syndrome and Toxic Shock Syndrome

Toxic Epidermal Necrolysis

Cleft occurs in the granular layer

Split occurs in the

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