By Gary M. White, MD
Pemphigus vegetans is a rare variant of pemphigus vulgaris in which vegetative lesions occur, typically in the intertriginous areas.
Flacid bulla and erosions which progress to vegetating, malodorous plaques in the intertriginous areas (e.g. groin, axilla) is characteristic of pemphigus vegetans whose histology and immunoflourescence show features of pemphigus vulgaris. Occasionally other areas may be involved, e.g. scalp [JEADV 2016;30;368]. Sulci and gyri on the dorsa of the tongue (called cerebriform tongue) have been described.
Prednisone and azathioprine are typically used. For example, one may use prednisone 40-60 mg/day and azathiprine 2-3 mg/kg/day with a maximum of 250 mg/day. Oral antibiotics are often given to treat any secondary infection. Cultures may direct therapy. Minocycline 100 mg/day and nicotinamide 500 TID cleared a case of PV in one week [BJD 1995;132;668]. Tetracycline 500 QID and niacinamide 500 TID has been used. For the vegetative or acanthotic changes, low dose acitretin may be used [CED 1998;23;178]. Spontaneous resolution may occur.
For more diagnostic and treatment information, see pemphigus vulgaris.
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