Pemphigus and beyond

A 23-year-old male diagnosed with pemphigus foliaceous presented with multiple asymptomatic hyperpigmented patches and plaques clinically resembling seborrheic keratoses over multiple sites on the body of 1-year duration. There were no fluid-filled lesions, active erosions, or mucosal involvement. Histopathological examination from the hyperpigmented plaque revealed marked acanthosis with intra-epidermal acantholysis. Enzyme linked immunosorbent assay (ELISA) for antidesmoglein-1 antibodies was positive with a titer of 157 units/ml. Treatment with oral azathioprine, dapsone, and topical halobetasol propionate produced a marked response with complete clearance of the lesions. A thorough workup helped us detect the persistence of disease activity and thus prevent a potential relapse. This case report highlights the unusual presentation of a common immunobullous disorder, Pemphigus acanthomata a rare entity with regard to its morphological, histopathological, and immunological features