A punch biopsy confirmed the suspicion of a dermatologist that the family physician (FP) had consulted; this was a case of pemphigus vegetans. Pemphigus vegetans, a variant of pemphigus vulgaris, is associated with vegetating proliferation of the epidermis. Pemphigus vegetans is usually seen in intertriginous areas like the axilla, groin, and genital region.
Once the biopsy was read as pemphigus vegetans, the dermatologist took over management of the patient. Management is very similar to that of pemphigus vulgaris, but the lack of oral involvement makes this condition easier to treat. In this case, the patient was prescribed prednisone 60 mg a day and topical clobetasol ointment twice daily to the affected area.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photos courtesy of Eric Kraus, MD. This case was adapted from: Mittal S. Pemphigus. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:794-798.
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