Pemphigus vulgaris 1_0313 Derm Dx
A Hispanic man, aged 60 years, complains of 12 months of painful blisters and erosions on his mouth and skin. He was treated in Mexico with oral prednisone, but the eruption returned on cessation of the medication. He was recently restarted on prednisone 50 mg daily. The sores make it difficult to eat. No other significant medical or family history was noted. Physical exam demonstrates erosions on his skin and mouth. There are also areas of post-inflammatory hyperpigmentation from prior erosions that have now healed. A punch biopsy demonstrates a blister with the epidermis split immediately above the basal layer. An Enzyme-linked immunosorbent assay of the patient’s serum demonstrates antibodies against desmoglein-3.