Pemphigus Vegetans — SCE Dermatology MCQ

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HardBlistering DiseasesPemphigus VegetansSCE Dermatology

A 50-year-old woman with a history of treated pemphigus vulgaris develops new skin lesions while on maintenance Mycophenolate mofetil. Biopsy of the new lesion shows verrucous epidermal hyperplasia without acantholysis. What is the most likely diagnosis?

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Correct answer: E — Pemphigus vegetans

Pemphigus vegetans is a clinical variant of pemphigus vulgaris characterised by vegetating (verrucous/hypertrophic) plaques that develop at sites of previous PV erosions, particularly in intertriginous areas. The Neumann type shows initial PV-like blisters followed by vegetating plaques; the Hallopeau type shows pustules evolving into vegetating plaques. Histologically, the verrucous hyperplasia may lack classical acantholysis (particularly in established vegetating lesions), but eosinophilic spongiosis and intraepidermal abscesses are present. DIF shows the same intercellular IgG pattern as PV. Treatment is as for PV.

Reference: BAD 2017 Pemphigus Guidelines