An unusual case of pemphigus erythematosus

Abstract

Pemphigus erythematosus is characterized by fragile vesicles or bullae, erosions, crusts, and scales in seborrheic area. There are several forms of atypical lesions such as erythematous papules and plaques, verrucous plaques, pustules, and lichenification. Here, we report an atypical pemphigus erythematosus with erythematous papules, plaques, and pustules skin lesions. A 52-year-old Indonesian man presented with prominent pruritic erythematous macules, papules, plaques on the scalp, trunk, and extremities, and also a pustule for each on the back and right arm. Clinically, the patient was diagnosed as small-plaque parapsoriasis, but histopathology examination on the pustule revealed a subcorneal acantholysis and direct immunofluorescence staining showed immunoglobulin G and complement C3 on the cell surface of keratinocytes. These result suitable for pemphigus erythematosus. The patient was treated with topical and systemic corticosteroid, and there were significant improvements in the skin lesions. Pemphigus erythematosus may present with prominent erythematous papules, plaques, and a few pustules. A careful assessment of the clinical manifestation and histopathological findings enabled us to make a correct diagnosis and succesfully treat the patient.