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Erythematous and partially denuded plaques in an elderly woman.

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Erythematous and partially denuded plaques in an elderly woman
Lia C. Keller M.D., Michael K. Zang M.D., and Arthur C. Huntley M.D.
Dermatology Online Journal: Volume 2 Number 1 : 4

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 2-4 mm 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).

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.
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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