A patient with pemphigus foliaceus is being treated. The histopathological hallmark that distinguishes it from pemphigus vulgaris is acantholysis occurring at the level of:

• A Suprabasal layer
• B Spinous layer (mid-epidermis)
• C Dermoepidermal junction
• D Subcorneal/granular cell layer ✓

Explanation

Pemphigus foliaceus shows acantholysis at the subcorneal/granular layer (superficial epidermis) because anti-Dsg1 antibodies disrupt desmogleins predominantly expressed in the upper epidermis. Pemphigus vulgaris shows suprabasal acantholysis because Dsg3 predominates in the lower epidermis. DIF shows intercellular IgG in both, but the split level is key to differentiation on biopsy.

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.