Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_1337_2023

Pemphigus foliaceous accompanied by new erythema annulare centrifugum like lesions

Department of Dermatology, Shengli Oilfield Central Hospital, Dongying, China
Hospital for Skin Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.

Corresponding author: Dr. Xiaopo Wang, Hospital for Skin Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China. 13770757675@163.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sun J, Wang X. Pemphigus foliaceous accompanied by new erythema annulare centrifugum like lesions. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_1337_2023

Dear Editor,

A 67-year-old otherwise healthy man presented with a 2-week history of mildly pruritic, erythema annulare centrifugum-like lesions involving the trunk and extremities. He had a medical history of pemphigus foliaceous (PF) localised on the chest since 5 years and had been irregularly taking oral prednisolone and topical clobetasol. The patient discontinued the treatment 6 months ago because he was worried about the side effects of corticosteroids. There were no identifiable inciting factors such as drug intake, recent infection or arthropod bite before the onset of the new lesions. Physical examination revealed an indurated, eroded, crusted plaque on the chest [Figure 1a]. Also, numerous demarcated, annular, erythematous plaques on the trunk and limbs were noted [Figures 1b and 1c]. There were no signs of mucous membrane involvement. An initial diagnosis of generalised tinea corporis was considered. However, a potassium hydroxide preparation of scrapings from the lesions was negative for fungal organisms. The results of laboratory studies, including full blood count, biochemistry, and antinuclear antibody profile were all within normal limits. Histopathological examination of a biopsy specimen taken from one of the erythema annulare centrifugum-like lesions showed mid-epidermal clefts containing acantholytic cells [Figure 2a]. Direct immunofluorescence on the normal-appearing perilesional skin revealed intercellular IgG and C3 staining in the epidermis [Figure 2b]. The ELISA test for anti-desmoglein autoantibodies was positive for desmoglein (Dsg)1 (74.0 U/mL, normal level<20) but negative for Dsg3. Taken together, a definitive diagnosis of erythema annulare centrifugum-like PF was established. The patient was prescribed oral prednisone 40 mg daily and topical mometasone furoate 1% cream. The erythema annulare centrifugum-like lesions disappeared completely and there was a partial clearance of the localised lesions on the chest after 4 weeks of treatment [Figures 3a and 3b].

Indurated, eroded, crusted plaque on the chest.
Figure 1a:
Indurated, eroded, crusted plaque on the chest.
Numerous demarcated annular, erythematous plaques on the trunk and limbs.
Figure 1b:
Numerous demarcated annular, erythematous plaques on the trunk and limbs.
Numerous demarcated annular, erythematous plaques on the trunk and limbs.
Figure 1c:
Numerous demarcated annular, erythematous plaques on the trunk and limbs.
Histopathological examination showed mid-epidermal clefts containing acantholytic cells. (Haematoxylin and eosin, 100x)
Figure 2a:
Histopathological examination showed mid-epidermal clefts containing acantholytic cells. (Haematoxylin and eosin, 100x)
Direct immunofluorescence on the normal-appearing perilesional skin revealed intercellular IgG staining in the epidermis. (200x).
Figure 2b:
Direct immunofluorescence on the normal-appearing perilesional skin revealed intercellular IgG staining in the epidermis. (200x).
Erythema annulare centrifugum-like lesions disappeared completely and there was a partial clearance of localised lesions on the chest.
Figure 3a-b:
Erythema annulare centrifugum-like lesions disappeared completely and there was a partial clearance of localised lesions on the chest.

PF is an acquired autoimmune vesiculobullous disorder that is characterised by granular layer acantholysis and antibodies to desmoglein 1 (Dsg1). Clinically, recurrent flaccid vesicles and bullae on an erythematous base are seen which are susceptible to rupture, resulting in crusted, scaling erosions.1 PF commonly presents with generalised involvement of the chest, back, and face. Rarely, it may be restricted to the initial site for a long period.2 Herein, we report a patient with previously localised PF on the chest, later developing new erythema annulare centrifugum-like lesions in which histology, immunofluorescence findings, and autoantibodies were compatible with PF.

Several cases have been described with an erythema annulare centrifugum-like clinical rash and direct immunofluorescence pattern compatible with pemphigus. The disease has been termed ‘erythema annulare centrifugum-like acantholytic dermatosis (EAAD)’ and some authors have proposed that it should be considered a novel acantholytic disease.3 However, Holahan HM et al. suggested EAAD may be a morphological variant of PF.4 Histopathologically, erythema annulare centrifugum-like PF or EAAD typically demonstrates subcorneal acantholysis or eosinophilic spongiosis without apparent acantholysis.4 Interestingly, the annular lesions of our patient showed mid-epidermal acantholysis. A similar case exhibiting erythema annulare centrifugum-like lesions accompanied by mid-epidermal acantholysis was documented and subsequently diagnosed as PF by immunoblotting.5 Thus, DIF staining pattern with intercellular deposition of IgG and C3 and ELISA identification of Dsg1 are essential for confirming the diagnosis.

Since a heterogeneous group of cutaneous diseases can present with erythema annulare centrifugum-like morphology, differential diagnoses are numerous and challenging. Diagnosis is made primarily by clinical and histological findings. In addition, other investigations such as microbiology and serology may be necessary to establish the cause of annular skin eruptions.

To the best of our knowledge, new erythema annulare centrifugum-like PF with previously localised PF has not been reported before. We also emphasise the importance of including PF in the differential diagnosis of erythema annulare centrifugum-like lesions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , , . Diagnosis and clinical features of pemphigus foliaceus. Dermatol Clin. 2011;29:405-12.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  2. , , , , , , et al. A rare cause of unilateral facial rash. Clin Exp Dermatol. 2019;44:425-7.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Erythema annulare-like acantholytic dermatosis (eaad): Nonbullous pemphigus or a new entity? Am J Med Sci. 1993;306:145-50.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , . Erythema annulare-like acantholytic dermatosis: A subset of pemphigus foliaceus. Br J Dermatol. 2014;171:1558-9.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , . Immunoblot assay as an aid to the diagnoses of unclassified cases of pemphigus. Arch Dermatol. 1991;127:843-7.
    [PubMed] [Google Scholar]

Fulltext Views
1,348

PDF downloads
675
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections