Acantholytic Herpetiform Dermatitis

A patient had an unusual blistering disease combining the features of both dermatitis herpetiformis and pemphigus vulgaris. The clinical features resembled dermatitis herpetiformis, and the disease was responsive to dapsone. Repeated biopsies, however, showed a mixture of features suggestive of both dermatitis herpetiformis and pemphigus vulgaris. Electron microscopic studies suggested pemphigus vulgaris. Her serum showed the serologic stigmata of pemphigus vulgaris, and intercellular IgG was demonstrated by direct immunofluorescence. Since this type of atypical blistering disease defies classification under the present criteria for diagnosis, and may prove to be a unique disease, it is suggested that patients whose disease resembles dermatitis herpetiformis with pronounced acantholysis be tentatively set aside under the category of ``acantholytic herpetiform dermatitis."