The diagnosis
Two stat shave biopsies—one from the edge of an erosion for hematoxylin and eosion staining, and the other of perilesional skin for direct immunofluorescence—revealed a diagnosis of pemphigus foliaceous.
The large areas of skin erosion impaired the skin barrier function and made this patient similar to a burn patient. The patient was at risk of dehydration and superinfection. As a result, IV fluids were started in the hospital and intake and output were measured. The dermatologist prescribed oral prednisone and topical triamcinolone ointment twice daily for the open erosions.
The patient survived under the care of the dermatologist.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photos courtesy of Eric Kraus, MD. This case was adapted from: Mittal S. Pemphigus. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:794-798.
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