Case Number : Case 2220 - 12 December 2018 Posted By: Iskander H. Chaudhry

Pemphigus foliaceus

acantholytic bulla -pemphigus foliaceous/vulgaris

However there is intense dermal inflammation look for associated castle mans disease

Could be a Pemphigus Vulgaris whit re-epithelialization?

Agree that the dermal inflamation probably is a clue for something else.

What about a solitary lesion like acantholytic acanthoma? It seems odd to do an incisional biopsy on a rash. It's super hard without a more defined clinical picture.

Dr Iskander, what's the 2204 case's diagnosis, please?

Agree with Uma's comment: my first spot is something like Warty Dyskeratoma. I don't know difference between acantholytic acanthoma and warty dyskeratoma. WD could have a multi follicular origin...  

Agree acantholytic acanthoma is a good suggestion. CPC obviously.

Dear all this was an unusual case as this is the only history we were given - I suggested if solitary acantholytic acanthoma but if more widespread blistering eruption then consider pemphigus and other suprabasal acantholytic disorders. Subsequent direct  immunofluorescence confirmed pemphigus vulgaris and clinician also confirmed more widespread eruption!