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June 2009

Exophytic Plaques, Blisters, and Mouth Ulcers—Diagnosis

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Arch Dermatol. 2009;145(6):715-720. doi:10.1001/archdermatol.2009.109-b

Histologic examination showed psoriasiform acanthosis, focal epidermal hyperkeratosis, and intraepidermal microabscesses composed of neutrophils, eosinophils, and acantholytic squamous cells (Figure 3). Eosinophils and neutrophils were also seen in the dermis. Direct immunoflourescence showed linear and granular C3 at the dermal-epidermal junction with patchy weak intercellular staining. Intercellular IgG staining was seen throughout the epidermis. Indirect immunofluorescence (IIF) on monkey esophagus revealed circulating intercellular IgG antipemphigus antibodies. Findings of IIF on rat bladder epithelium were negative. Treatment with an oral prednisolone taper starting at 120 mg/d; dapsone, 100 mg/d; and acitretin, 40 mg/d, resulted in good improvement. A persistent exophytic plaque on the left axilla was resurfaced using carbon dioxide laser.

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