Persistent erosions of the glans penis and foreskin

A 66-year-old man presented with an 8-month history of persistent erosions of the glans penis and foreskin with slight itching and pain.Physical examination revealed erythema and superfi cial erosions on the glans penis and foreskin (Figure 1).Similar lesions were not found on the skin or oral mucosa elsewhere.Tests for syphilis were negative.Biopsy taken from the foreskin showed suprabasal bullae with acantholysis.Direct immunofl uorescence was negative for deposition of immunoglobulin (Ig) G, IgA, and IgM and complement C3 in the epidermal cells and basement membrane bands.However, indirect immunofl uorescence tests showed that antispinous intercellular desmoglein antibodies were deposited in the interspinous cell reticulum (using monkey esophagus as a deposition substrate) at a titer of 1:320.No antibasement membrane zone antibodies (important autoantibodies in the diagnosis of bullous pemphigoid) were found.