Pemphigus vegetans presenting as acrodermatitis continua suppurativa

Area of Science:

• Dermatology
• Immunohistopathology

Background:

• Acrodermatitis continua suppurativa is a rare skin condition.
• Distinguishing it from other blistering diseases can be challenging.

Observation:

• A 51-year-old patient presented with symptoms initially suggestive of acrodermatitis continua suppurativa.
• Histological examination was inconclusive, prompting immunohistology.
• Clinical progression revealed vegetating formations, and repeat histology showed suprabasal clefts and eosinophilia.

Findings:

• Intercellular epidermal fluorescence on immunohistology was a key diagnostic indicator.
• Combined clinical, histological, and immunohistological findings confirmed a diagnosis of pemphigus vegetans Hallopeau.
• This specific presentation involved phalangeal and nail regions, a rare manifestation.

Implications:

• Accurate diagnosis of pemphigus vegetans Hallopeau is crucial for effective treatment.
• The case highlights the utility of immunohistology in complex dermatological diagnoses.
• Successful treatment was achieved with cyclosporine-A and low-dose steroids, offering a therapeutic option.