Présentation Clinique

Clinical Setting

F 64 ans, présentant des lésions erythémato-squameuses généralisées, prurigineuses, évoluant depuis plusieurs semaines.

Biopsie chirurgicale de la région abdominale:

F 64 yo, complaining of erythematous, scaly lesions, diffuse, evolving for few weeks.

Surgical biospy of the abdominal area.

IgG

C3

Diagnostic Proposé:

Pemphigus Foliacé

Proposed diagnosis:

Pemphigus Foliaceus

Arguments

Since the blisters of p. foliaceus are superficial, they are therefore fragile and are often very difficult to obtain an intact lesion for diagnosis. Patients commonly have erosions without blisters, and frequently the clinician does not suspect a bullous disorder.

Usually the cleft or blister lies within the granular layer or beneath the stratum corneum . The roof of the fragile blister is often not present, having sloughed either before or after biopsy. Acantholysis is frequently difficult to detect, but usually a few acantholytic cells can be found attached to the roof or floor of the blister. In those cases where the blister is missing, a careful inspection of the hair follicles may reveal focal acantholysis. Sometimes the blister contains numerous acute inflammatory cells, particularly neutrophils, which can make distinction from subcorneal pustular disorders especially difficult. Eosinophilic spongiosis may also be seen.

 

Reference, for more details

Pemphigus foliaceus

Pemphigus Vulgaris

(Ref. Pathology of the skin, PH McKee, 3rd Ed. Elsevier-Mosby)