[Pemphigus vegetans, a clinical type of chronic pustular dermatitis of Hallopeau]

A 49-year old woman had an eruption resembling 'dermatite pustuleuse chronique en foyers a progression excentrique' as initially described by Hallopeau. Numberous vegetating lesions occurred over the genitocrural, pubic, umbilical and submammary regions. The finger-nails showed onycholysis and sterile pustules. No bullae were seen at any time. Histopathological study revealed the presence of acantholysis. Direct immunofluorescent microscopy showed IgG deposits in the intercellular epidermal space. The titer of pemphigus antibody was 1/1,600: the results of these immunofluorescence studies on early pustular lesions as well as vegetating lesions support the view that Hallopeau disease belongs to the 'pemphigus group'. The patient was treated first with oral prednisone (80 mg/day). In twelve months of follow-up care, the vegetating lesions disappeared completely, leaving hyperpigmentation. Prompt recurrence of lesions was observed when corticosteroids were discontinued; reinstitution of this therapy was followed by their regression. A difference exits between pemphigus vegetans of Hallopeau and pemphigus vegetans of Neumann: (1) the Hallopeau type begins with pustules as the primary lesions, followed by vegetations, with a lack of bullae and a preference for flexural areas. Immunofluorescence studies will be the deciding factor in separating pemphigus vegetans of Hallopeau from pyoderma vegetans. (2) The Neumann type is a variant of pemphigus vulgaris in which the denuded areas have a tendency to heal with papillomatous formations. It begins and ends with bullae.