Intraepidermal Vesiculobullous Dermatitis

Question 1

Intraepidermal Vesiculobullous Dermatitis

DDX

Answer 1

1. Pemphigus vulgaris
2. Hailey-Hailey disease
3. Pemphigus foliaceus
4. RE-epithelializing subepidermal blistering disorders

Question 2

Pemphigus vulgaris

Answer 2

Histology

1. Suprabasilar acantholysis with tombstoning of remaining basal keratinocytes
2. DIF shows intercellular IgG and C3

DDX

1. Darier’s
2. Grover’s
3. fixation artifact in oral mucosa (full thickness)

Question 3

Hailey-Hailey disease

Answer 3

Aka benign familial pemphigus

1. dilapidated brick wall with full thickness and suprabasilar acantholysis

Question 4

Pemphigus foliaceus

Answer 4

Histology

1. cleavage at granular layer (beware of missing stratum corneum)
2. DIF: intercellular IgG and C3 (may be in upper layers of epidermis)

​DDX:

staph scalded skin syndrome

Question 5

Re-epitheliazing subepidermal blistering disorders

Answer 5

History and exam of several biopsies is needed

often have squamization in blister floor