A 35-year-old man develops malodorous, vegetating plaques in the axillae and groin after ruptured flaccid blisters. Oral erosions are present. Biopsy of a plaque shows intraepidermal abscesses rich in eosinophils with suprabasal acantholysis. The initial lesion in this subtype classically begins as:

• A Pustule (Hallopeau type)
• B Macule (Neumann type)
• C Nodule (Hallopeau type)
• D Vesicle (Neumann type) ✓

Explanation

In the Neumann type of pemphigus vegetans, vesicles rupture and heal into vegetating masses, and this is the more common and more severe form. In the rarer Hallopeau type, the primary lesion is a pustule and the course is more benign. Both types share suprabasal acantholysis with prominent intraepidermal eosinophilic microabscesses.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.