A diagnostically challenging case of pemphigus foliaceus without histologic evidence of acantholysis.

Jennifer Y Liu, Philip Scumpia, Catherine Ni, Sharona Yashar, Kathy Langevin, Yuna Kang, Amy Vandiver

Abstract readCase Reports

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Article in Dermatology online journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

Jennifer Y LiuDivision of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Philip ScumpiaDivision of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Catherine NiDepartment of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Sharona YasharDepartment of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Kathy LangevinDepartment of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Yuna KangDepartment of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Amy VandiverDivision of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

A 77-year-old woman presented with pruritic, scaly, erythematous papules and plaques on the face, which subsequently spread to the trunk. Over nearly 2 years, 5 skin biopsies were performed, consistently suggesting a subacute to chronic eczematous process without acantholysis or intraepidermal bullae. After 2 years of unsuccessful treatment, enzyme-linked immunosorbent assay demonstrated elevated anti desmoglein-1 IgG and normal anti desmoglein-3 IgG. Direct immunofluorescence of a skin biopsy revealed IgG and C3 deposition in the intercellular spaces. A diagnosis of pemphigus foliaceus was established, and the patient was treated with rituximab, resulting in significant clinical improvement. This case illustrates a diagnostically challenging presentation of pemphigus foliaceus in which multiple biopsies failed to demonstrate acantholysis or intraepidermal bullae (classic histologic features) highlighting the importance of immunologic testing in the evaluation of suspected autoimmune blistering disorders.

Indexed as

PemphigusAcantholysisAgedBiopsyComplement C3Desmoglein 1Desmoglein 3FemaleHumansImmunoglobulin GImmunologic FactorsRituximabSkinComplement C3Desmoglein 1Desmoglein 3Immunoglobulin GImmunologic FactorsRituximabacantholysisautoimmune bullous dermatosispemphigus foliaceus

Identifiers

PMID42246332

DOI10.3390/dermatopathology9020022

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