A 50-year-old woman presents with superficial erosions over the face and chest. Biopsy shows subcorneal acantholysis with a grain-like pattern. DIF shows IgG in an intercellular pattern. Anti-desmoglein 1 antibodies are positive with negative anti-desmoglein 3. What is the diagnosis?

• A Pemphigus vulgaris
• B Pemphigus foliaceus ✓
• C Hailey-Hailey disease
• D Staphylococcal scalded skin syndrome

Explanation

Pemphigus foliaceus is characterized by superficial, easily ruptured blisters that heal as scaly erosions because the cleavage plane is subcorneal (just below the stratum corneum). The target antigen is exclusively desmoglein 1 (expressed only in the superficial epidermis), explaining the absence of mucosal involvement since desmoglein 3 compensates in mucosae. The endemic form in Brazil is called fogo selvagem. DIF shows the same intercellular IgG pattern as pemphigus vulgaris but the histology shows high subcorneal cleavage.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.