Persistent pemphigus vulgaris showing features of tufted hair folliculitis

Abstract

Pemphigus vulgaris is an autoimmune blistering disease that commonly involves the scalp. Lesions of pemphigus vulgaris that persist on the scalp for a long period may be accompanied by tufted hair folliculitis. Only two previous accounts of tufted hair folliculitis developing in a lesion of pemphigus vulgaris have been reported. We report a 51-year-old-man with erosions and clusters of hair on the scalp. The scalp lesion had persisted for about 20 years. A histopathological examination of the skin lesion on the scalp revealed separation of the epidermis and clusters of several adjacent hair follicles. The patient was diagnosed with persistent pemphigus vulgaris of the scalp showing features of tufted hair folliculitis.

Keywords: Pemphigus vulgaris; Tufted hair folliculitis.

Fig. 1

Multiple irregular erosions accompanied by crusts and hair loss on the scalp. Clusters of hairs appear to emerge from individual follicular openings in the area of crusting.

Fig. 2

(A) Separation of the epidermis and clustering of several adjacent hair follicles is shown on crusted lesions of the scalp (H&E, ×20). (B) Separation of the epidermis above the basal layer and scattered acantholytic cells are observed (H&E, ×100). (C) Skin biopsy obtained from the scalp. Separation and loss of the epidermis above the basal layer and row of tombstone pattern cells is observed (H&E, ×100).