Interactive Case Study - December 2016

Intertriginous Lesions

Kathryn E. Buikema DO, MPH

Nicholas Logemann DO

The patient presented with intertriginous lesions.

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Direct Immunofluorescence demonstrates the “chicken wire” pattern of intercellular IgG in the inferior epidermis on the surface of the keratinocyte.

What is the best diagnosis?

Familial benign chronic pemphigus

Keratosis follicularis

Pemphigus vegetans

Pemphigus vulgaris

Verruciform xanthoma

What would be the anticipated direct immunofluorescence staining pattern in pemphigus vegetans?

Most similar to IgA pemphigus

Most similar to paraneoplastic pemphigus

Most similar to pemphigus foliaceus

Most similar to pemphigus vulgaris

Negative direct immunofluorescence

de Almeida HL Jr, Neugebauer MG, Guarenti IM, Aoki V. Pemphigus vegetans associated with verrucous lesions: expanding a phenotype. Clinics (Sao Paulo). 2006 Jun;61(3):279-82. Epub 2006 Jun 30. PMID: 16832564 DOI: /S1807-59322006000300016
James, WD, Berger, TG, Elston, DM, et al. Chronic Blistering Dermatoses. Andrews’ Diseases of the Skin, 12th ed. Philadelphia, PA: Elsevier; 2016: 451-470.
Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier, 2010.
Young-Min S, Hong-Kyu, K, Jeong-Hwan, Y, et al. The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid. Ann Dermatol. 2011 Dec; 23(Suppl 3): S310–S313. Published online 2011 Dec 27. doi: 10.5021/ad.2011.23.S3.S310.

Acknowledgements

Author Profiles

Kathryn E. Buikema

Lieutenant Commander, United States Navy Medical Corps

Lieutenant Commander Buikema is a General Medical Officer at Fort Belvoir Community Hospital in Alexandria, Virginia.

Nicholas Logemann

United States Navy Medical Corps

Lieutenant Commander Logemann is a staff Dermatologist and Dermatopathologist at Walter Reed National Military Medical Center in Bethesda, Maryland USA.

Question:

Interactive Case Study - December 2016

Acknowledgements

Author Profiles

Intertriginous Lesions

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