Fifteen month history of partially denuded eruption with blisters over the face and trunk.
History
77-year old woman referred for
evaluation of an erythematous,
partially denuded eruption over
her face and trunk of 15 months
duration. The eruption began
with an enlarging area of red-
ness confined to her left cheek
and spread despite treatment
with antibiotics, topical and
intra-lesional corticosteroids.
She had no constitutional
symptoms throughout the course
of her illness. Laboratory eval-
uations including skin cultures
were negative. Three consecutive
skin biopsies were interpreted
as psoriasiform dermatitis.
Physical Examination
She had well-demarcated ery-
thematous and partially denuded
plaques in a seborrheic distri-
bution over her face, chest,
and back. Several 2-4mm flaccid
vesicles were present within
the facial plaques.
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Subcorneal cleft with acantholysis.
Histology
A punch biopsy of involved
facial skin revealed acantho-
lysis within the granular layer
layer forming a subcornea cleft,
and a sparse perivascular
lymphoplasmacytic infiltrate
in the papillary dermis.
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IgG within the intercellular spaces of the epidermis and C3 confined to those granular layer keratinocytes forming the floor
of the cleft.
Immunofluorescence
Direct immunofluorescence studies
revealed IgG within intercellular
spaces of the epidermis and C3
confined to those granular layer
keratinocytes forming the floor
of the cleft. Indirect immuno-
fluorescence for pemphigus
antibody was present at a titer
of 1:40.
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