A 40-year-old man presents with recurrent pustules in the axillae and groin that rupture and coalesce into hypertrophic, vegetating plaques. Oral erosions are minimal. Biopsy shows suprabasal acantholysis with marked pseudoepitheliomatous hyperplasia and intraepidermal abscesses rich in eosinophils. Which variant of pemphigus does this represent?

• A Pemphigus vegetans of Neumann type
• B Paraneoplastic pemphigus
• C Pemphigus foliaceus
• D Pemphigus vegetans of Hallopeau type ✓

Explanation

Hallopeau type begins as grouped pustules that evolve directly into vegetative plaques, runs a relatively benign course, and often responds to dapsone. The Neumann type starts as typical pemphigus vulgaris blisters and develops vegetation during healing, following a more severe course. Pseudoepitheliomatous hyperplasia with eosinophilic abscesses is characteristic of both types, so the pustular onset decides the answer.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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