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A 77-year old woman was referred to our clinic 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 redness confined to
her
left cheek and spread despite treatment with antibiotics, topical and
intralesional corticosteroids. She had no constitutional symptoms throughout
the course of her illness. Laboratory evaluations, including skin cultures,
were
negative. Three consecutive skin biopsies were interpreted as psoriasiform
dermatitis.
At presentation, she had well-demarcated erythematous and partially denuded plaques in a seborrheic distribution over her face, chest and back. Several 2-4mm flaccid vesicles were present within the facial plaques. Laboratory evaluation, including chemistry panel, complete blood cell count, erythrocyte sedimentation rate, RPR and urinalysis were all within normal limits. Serum antinuclear antibody was present at a titer of 1:40 (speckled pattern).
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| A punch biopsy of involved facial skin revealed acantholysis within the granular layer forming a subcorneal cleft, and a sparse perivascular lympho-plasmacytic infiltrate in the papillary dermis. |
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| Direct immunofluorescence studies revealed IgG within the intercellular spaces of the epidermis and C3 confined to those granular layer keratinocytes forming the floor of the cleft. Indirect immunofluorescence for pemphigus antibody was present at a titer of 1:40. |
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