We present a 58-year-old Jamaican man with an eight-month history of an isolated, vegetative, eroded, and crusted plaque on the posterior aspect of the scalp. One month prior to referral to the Charles C. Harris Skin and Cancer Pavilion he developed a few, scattered erosions on the extremities. A biopsy specimen showed suprabasal acantholysis along with deposition of C3 and IgG on a direct immunofluorescence test. Localized pemphigus is a rare variant of pemphigus vulgaris. Localized pemphigus presents with a localized plaque that remains localized for an extended period of time without generalized bullae formation. Our patient represents an unusual case of localized pemphigus of the scalp with vegetative features.
Complete blood count, basic metabolic panel, liver function tests, Quantiferon Gold assay for tuberculosis, and hepatitis serologies were normal. Human immunodeficiency virus was absent. A potassium hydroxide preparation of the posterior aspect of the scalp was negative for fungal elements. Indirect immunofluorescence tests showed IgG with a titer of 1:320 on monkey esophagus and 1:160 on human skin. Desmoglein 1 antibody was 90 units and desmoglein 3 antibody 34 units.
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