Facial erosions and scalp lesions in a middle-aged man
A 55-year-old man reported a several-week history of crusted scalp lesions and red facial erosions accompanied by an irritated, burning sensation. He did not recall any pre-erosion blisters. An examination was otherwise normal, including clear mucous membranes. Punch biopsy revealed an epidermis that was superficially denuded just below the granular layer. Direct immunofluorescence (DIF) of perilesional intact skin demonstrated intracellular immunoglobulin (Ig) G deposition within the epidermis.