Chronic “Vegetative” Pemphigus Foliaceus: A Novel Histopathologic Variant

Pemphigus foliaceus (PF) is the second most common subtype among the pemphigus disorders, and is typically characterized by superficial, fragile bullae in a seborrheic distribution. We present a unique case of diffuse PF that mostly resolved with standard therapy but left a few recalcitrant thick "vegetative" plaques. While a psoriasiform presentation of pemphigus foliaceus has been reported, our findings may exist on a spectrum; to our knowledge, this is the first report of persistent "vegetative" lesions of PF in an otherwise classic presentation, raising important questions regarding the pathogenesis of this clinical variant.