Abstract
We report a 49-year-old woman who presented in 1999 with oral erosions and cutaneous erosions and was diagnosed with pemphigus vulgaris. The patient was treated with pulsed methylprednisolone, pulsed cyclophosphamide, plasma exchange therapy and azathioprine. She was then free from any lesion of pemphigus vulgaris with 5mg of prednisolone, and both Dsg1 and Dsg3 antibodies were below the threshold of detection. In June 2009, scattered scaly small erythematous lesions appeared on her face and lower limbs. A biopsy of a skin lesion showed intraepidermal blister that splits at the level just beneath the stratum granulosum and acantholysis, and only Dsg1 antibodies were detected at high levels. The transition from a pemphigus vulgaris phenotype to pemphigus foliaceus was mirrored in this case by striking changes in the Dsg1 and Dsg3 autoantibody levels.Skin Research, 12: 83-87, 2013
