Vulgaris of the Scalp
Foong MRCP (UK)
December 31, 2000
patient, a 54-year-old Chinese man, presented with a 6-week history
of a crusted patch on the right temporal area. It had started off
as a "10 cent coin" lesion and gradually increased in size. It was
not painful. He was otherwise well and had no constitutional symptoms.
He denied keeping any pets at home. In 1997 he had pemphigus vulgaris
and had since been stabilised on prednisolone 10mg daily. His other
medications were glibenclamide for adult onset diabetes mellitus.
He noted that his pemphigus started off as a patch at the same area
of the scalp years ago before spreading to the trunk and extremities.
was a solitary superficial erosion 6 by 5 cm on the right temporal
area. The surface appeared raw and crusted. The hairs within the lesion
apparently were not affected. His regional nodes were not enlarged.
No blisters or erosions were noted elsewhere.
cavity and nails were normal. Hairs were sent for fungal culture.
He was given an initial therapeutic trial of griseofulvin for 3 weeks
but there were no improvement. A skin biopsy was done on the lesion.
Pemphigus vulgaris of the scalp
Some of the differentials would include tinea capitis
and squamous cell carcinoma. Biopsy showed an intraepidermal blister
with acantholysis. Though immunofluorescence studies were not done,
this histological findings would be sufficient to make a diagnosis
of pemphigus vulgaris.
Victoria P Werth, M.D., Associate Professor
of Dermatology, University of Pennsylvania School of Medicine, Philadelphia,
It is not unusual to see relapses of pemphigus. From
the history and photo, that would be my first diagnosis. Since there
are implications for therapy, I would repeat a biopsy and meanwhile
treat with intralesional kenalog and intermittent pulse topical steroids
(2 days a week). If new lesions develop or this one doesn't heal,
then I would consider increasing prednisone. You should treat with
calcium and bisphosphonates (consider getting DEXA scan) for bone
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