Pemphigus vegetans is an uncommon subcategory of pemphigus vulgaris, which is an autoimmune vesiculobullous disease causing a characteristic appearance with numerous flaccid intraepidermal bullae and recurring lesions.
Pemphigus vegetans is a broader term that encompasses two disease types: the Hallopeau type and the Neumann type. The hallopeau disease type displays a less aggressive course and initially manifests with pustules, which, upon eruption lead to the formation of pink papillomatous lesions . The Neumann type, on the other hand, starts to manifest with vesicles and bullae and follows a course with more outbreaks and a reduced response to therapeutic intervention. The lesions that develop during the disease are significantly more extensive than those of the Hallopeau type .
Both types of pemphigus vegetans are characterized by initial lesions, either pustules or bullae, which progressively assume vegetative characteristics and hypertrophy and are frequently misdiagnosed as warts. The vegetative lesions can expand considerably, with new bullae or pustules developing around their borders.
Entire Body System
CASE REPORT A 45-year-old wood furniture painter was brought to the dermatology outpatient department with complaints of recurrent painful oral erosions for the last three years. [ncbi.nlm.nih.gov]
A 45-year-old wood furniture painter was brought to the dermatology outpatient department with complaints of recurrent painful oral erosions for the last three years. [idoj.in]
- Increased Susceptibility to Infections
This condition is associated with a decrease in Th1 cytokines interleukin-2 and interferon-γ, eventually resulting in an increased susceptibility to infection and protection against autoimmunity. [karger.com]
A patient with painful erosions of the oral cavity and the labia minora developed multifocal blisters in inter-triginous areas. These blisters eroded and evolved into papillomatous erosive vegetations. [ncbi.nlm.nih.gov]
Sometimes, the blisters spread to the voice box, causing hoarseness. A few weeks or months later, blisters may start to form on the skin. [news-medical.net]
blister), is also required for direct immunofluorescence (DIF). [pcds.org.uk]
- Nikolsky's Sign
Different types of Nikolsky’s sign: Marginal Nikolsky’s sign : Erosion of perilesional skin on the application of pressure is called marginal Nikolsy s sign. This sign is 69 % sensitive in detecting PV. [lecturio.com]
Lesions heal without scarring The Nikolsky sign is positive - this is where firm sliding pressure with a finger will cause an erosion Flexural involvement readily forms vegetating granulomas Nails Acute or chronic paronychia, subungual haematomas, and [pcds.org.uk]
[…] blisters and erosions on trunk, face, scalp, and proximal limbs, positive Nikolsky sign Pemphigus vegetans – intertriginous and oral with involvement of tongue (cerebriform tongue) Flaccid bullae and erosions (Neumann type) Pustules (Hallopeau type) [arupconsult.com]
Nikolsky sign was negative. [njcponline.com]
The Nikolsky sign is not specific for pemphigus vulgaris and may also be observed in other skin blistering diseases such as pemphigus foliaceus, staphylococcal scalded skin syndrome, and toxic epidermal necrolysis. [clinicaladvisor.com]
Regression left a pigmented macula. [scirp.org]
- Chronic Dermatitis
But plasma cells could be a histopathological feature of most of the cases with chronic dermatitis. [e-ijd.org]
She also had hyperkeratotic plaques on the borders of both feet ( Figure 2 ), as well as verrucous paronychia of the 20 nails ( Figure 3 ) with pachyonychia and onychorrhexis. Laboratory tests were normal. [scielo.br]
For an accurate diagnosis of pemphigus vegetans to be made, the initial step involves diagnosing the wider pathology, which is essentially pemphigus vulgaris. A histopathologic analysis from the blister's margin, direct immunofluorescence (DIF) on the skin adjacent to the lesion that appears normal and indirect immunofluorescence (IDIF) in the serum after DIF has yielded positive results, are all useful tools towards the diagnosis of the disorder.
- Histopathology: a histologic analysis can delineate the background of blister formation; it clearly illustrates the detachment of the suprabasal epidermal cells from their basal counterparts in such a way that bullae are formed. Typically, basal cells remain connected to the basement membrane, even though they assume positions at a distance from one another. Signs of acantholysis are evident within blister cells . Epithelial hyperplasia is a finding that is common amongst patients affected by pemphigus vulgaris .
- DIF: It usually illustrates immunoglobulin G (IgG) deposits on the superficial side of keratinocytes, with the primary Ig subclasses being IgG1 and IgG4. Deposits of other immune reactants can be detected occasionally, including complement components and IgM. DIF is carried out on skin that has been harvested from the area that surrounds the lesion and has a normal-looking appearance . The results of a DIF, however, are non-specific to pemphigus vulgaris.
- IDIF: Due to the low specificity of the DIF test, in the light of positive results, an IDIF is required. This test can detect IgG autoantibodies in the serum, attached to the epidermal layer of the skin. Intercellular antibodies in the serum are detected in the vast majority of the patients affected by pemphigus vulgaris.
Findings, such as the ones described above, that correlate to pemphigus vulgaris, combined with a clinical presentation associated with pemphigus vegetans are the key to achieving a precise diagnosis of the latter.
Possible active components of the treatment are discussed. [ncbi.nlm.nih.gov]
With long-term treatment, the condition can sometimes be controlled to the point that flare-ups no longer occur even after treatment is stopped. The treatments used to manage pemphigus vulgaris are similar to those used to treat severe burns. [news-medical.net]
Treatment of severe PV often poses great problems. Systemic corticosteroid therapy is still the mainstay of treatment for pemphigus. However, the treatment is limited by various adverse effects. [jamanetwork.com]
Its prognosis is similar to pemphigus vulgaris. The controversy boils down to whether pemphigus vegetans of Hallopeau and pyodermite végétante (pyoderma vegetans) are separate diseases. [jamanetwork.com]
The prognosis for patients with this condition is much more positive than for patients with pemphigus vulgaris. [news-medical.net]
The Hallopeau type has a relatively benign course and responds to topical therapy, low dose steroids and occasionally to dapsone while the Neumann type has a poor prognosis and is resistant to treatment. [e-ijd.org]
PH is a rare form of pemphigus vegetans and it has a better prognosis with 1% to 2% of spontaneous remission . It is also considered as an infectious disease  or as a disease associated with inflammatory enterocolitis . [scirp.org]
The findings were typical of pemphigus, confirming the propriety of classifying this entity as a benign variant of pemphigus, rather than a disease of purely microbial etiology. [ncbi.nlm.nih.gov]
OBJECTIVE: In this retrospective study of P Veg, we aimed to analyse epidemiological, clinical, immunopathological and therapeutic data. Study of prognostic factors with accuracy of patient survival was also carried out. [ncbi.nlm.nih.gov]
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Epidemiologic analysis and clinical course of 84 consecutive cases of pemphigus in eastern Sicily. Int J Dermatol. 1998;37:197-200. 2. Mahé A, Flageul B, Cissé I, Kéita S, Bobin P. Pemphigus in Mali: a study of 30 cases. [scielo.br]
Pemphigus in Indian patients has unique genetic, clinical, and epidemiological differences from those in the Western countries. Corticosteroids remain the mainstay of treatment for pemphigus. [ijdvl.com]
CIC Edizioni Internazionali, 28 oct. 2015 - 442 pagini Vulvar-vaginal disorders represent a field of growing interest in clinical, epidemiological and healthcare research. [books.google.ro]
However, the pathophysiological significance of anti-periplakin reactivity in this pemphigus variant remains to be determined. [ncbi.nlm.nih.gov]
Pathogenesis Pathophysiology Postulated that it is a benign form of pemphigus vulgaris Skin: pemphigus vulgaris in dogs with some resistance to the disease. [vetstream.com]
The pathophysiological significance of nondesmoglein targets of pemphigus autoimmunity: development of antibodies against keratinocyte cholinergic receptors in patients with pemphigus vulgaris and pemphigus foliaceus Arch Dermatol 1998;134971- 980 PubMed [jamanetwork.com]
Pathophysiology The immune mechanisms causing the loss of tolerance to desmogleins are unknown, although certain MHC class II alleles are more often associated with pemphigus vulgaris (HLA DRB1*0402 and DQB1*0503). [clinicaladvisor.com]
If necessary, patients can take a short (1-2 week) course of prednisone surrounding their cleanings to prevent flares of disease. [clinicaladvisor.com]
Treatment is aimed at reducing pain and symptoms and preventing complications like infection. It involves one or more drugs and other methods. [healthline.com]
Improved access to gynecological care and lengthening of life expectancy are the basis of increased incidence of chronic disorders requiring early diagnosis, prolonged treatment and adequate follow-up, in order to prevent development of neoplastic diseases [books.google.ro]
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- Cozzani E, Christana K, Mastrogiacomo A, et al. Pemphigus vegetans Neumann type with anti-desmoglein and anti-periplakin autoantibodies. Eur J Dermatol. 2007;17:530–533.
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- Helander SD, Rogers RS 3rd. The sensitivity and specificity of direct immunofluorescence testing in disorders of mucous membranes. J Am Acad Dermatol. 1994 Jan. 30(1):65-75.