Pemphigus foliaceus resembling eruptive seborrheic keratoses

Abstract

A 78-year-old man had an acute eruption of lesions that clinically resembled seborrheic keratoses. Microscopic examination of the lesions indicated acantholysis and dyskeratosis primarily in the granular layer. The patient's serum contained antibodies to intercellular substance. Direct immunofluorescence microscopy of a lesion demonstrated immunoglobulin deposition in the intercellular areas. Treatment with oral prednisone produced rapid resolution of the lesions. Patients in whom eruptive seborrheic keratoses (Leser-Trélat sign) develop should have histological examination of their lesions to rule out the diagnosis of pemphigus foliaceus.

Pemphigus Vulgaris Associated with Transient Acanthosis Nigricans Like Lesion

“…Dermatoses similar to that presented here have been reported as seborrheic keratosis or acanthosis nigricans. Bruckner et al (1) reported a patient whose dermatoses were clinically similar to eruptive seborrheic keratoses. Kahana (5).…”

Comprehensive review on the pathophysiology, clinical variants and management of pemphigus (Review)

“…In the localized version (pemphigus erythematosus/Senear-Usher syndrome), the lesions are similar to the malar erythema present in lupus erythematosus (strongly scaled erythematous plaques) that appear on sun-exposed areas such as the scalp, face and upper torso (8,12,(74)(75)(76)81). Pemphigus erythematosus mainly affects elderly patients, and medications, sun exposure and trauma are considered possible triggers (8,80,81). In approximately 80% of these cases, immunoreactive deposits along the basement membrane and a mean titer of antinuclear antibodies can be detected, usually without the presence of anti-ds-DNA antibodies, which may suggest an association with lupus erythematosus (8,80,81).…”

“…Pemphigus erythematosus mainly affects elderly patients, and medications, sun exposure and trauma are considered possible triggers ( 8 , 80 , 81 ). In approximately 80% of these cases, immunoreactive deposits along the basement membrane and a mean titer of antinuclear antibodies can be detected, usually without the presence of anti-ds-DNA antibodies, which may suggest an association with lupus erythematosus ( 8 , 80 , 81 ). In PF a common clinical finding is a positive Nikolsky sign, which is very specific in the diagnosis of pemphigus.…”

“…In the endemic version (fogo selvagem), the erosions are intensely painful, like 'wild fire', and predominantly affect young women in endemic regions (8,74). In the localized version (pemphigus erythematosus/Senear-Usher syndrome), the lesions are similar to the malar erythema present in lupus erythematosus (strongly scaled erythematous plaques) that appear on sun-exposed areas such as the scalp, face and upper torso (8,12,(74)(75)(76)81). Pemphigus erythematosus mainly affects elderly patients, and medications, sun exposure and trauma are considered possible triggers (8,80,81).…”

“…Unusual presentations of PF have also been described, such as an acute rash with multiple hyperpigmented and hyperkeratotic lesions similar to seborrheic keratoses, lesions resembling impetigo, and scaly erythema on the scalp that may be confused with seborrheic dermatitis (74,(80)(81)(82). In cases of sporadic PF in children, patients have the same primary lesions (blisters) and secondary lesions (erosions), but with a distinct configuration that has been described as arcuate, circinate and/or polycyclic (81)(82)(83). Pemphigus seborrhoicus is a special form of PF, with very superficial blisters, extensive erythematous plaques and erosions that develop in the seborrheic areas (4,12).…”