Pemphigus Vulgaris with Loss of Hair on the Scalp
We report on a 32-year-old female patient who presented with a 2-year history of flaccid bullae over her upper trunk, erosions over her oral mucosa and hard palate, and several crusted erosions over her scalp. The clinical as well as the pathological and direct immunofluorescence findings supported the diagnosis of pemphigus vulgaris and the patient was treated with systemic steroids and mycophenolate mofetil as a steroid sparing agent with clinical improvement, except for the lesions on her scalp. The erosions on the scalp were treated with high potency topical steroids with good clinical response; however several months later the patient returned with scalp folliculitis, which later progressed to indurative tender plaques with loss of hair over the involved areas on her scalp []. Biopsy taken from the lesion was compatible with the diagnosis of pemphigus vulgaris, demonstrating acantholysis of the epidermal as well as the outer root sheath keratinocytes []. Direct immunofluorescence demonstrated immunoglobulin G deposition on the intercellular spaces within the epidermis []. Scalp swab taken from the lesion cultured Staphylococcus aureus.\nThe patient was treated initially with systemic steroids, and later on the steroids were gradually replaced with mycophenolate mofetil, combined with low dose triamcinolone tablets given for her mucosal lesions. In addition, she was treated locally with high-potency topical steroid. The above mentioned treatment led to the regression of the lesions on her scalp, and later to re-growth of hair.