Question

A 30 year old woman came with flaccid bullae on her skin which were easy to rupture. Biopsy of the lesion revealed a suprabasal split. What is the most likely diagnosis?

• A. Pemphigus vegetans
• B. Pemphigus vulgaris
• C. Pemphigus foliaceous
• D. Erythema multiforme

Answer 1

The Correct Option is B

A 30-year-old woman presents with flaccid bullae on her skin that are easy to rupture. A biopsy reveals a suprabasal split. This information helps narrow down the differential diagnosis in dermatology, focusing primarily on autoimmune blistering diseases.

When considering the clinical presentation and histopathological findings:

• Flaccid bullae: These suggest separation within the epidermal layer rather than subepidermal, typical in certain autoimmune conditions like pemphigus.
• Suprabasal split: Histologically indicates acantholysis occurring just above the basal layer of the epidermis.

Review of the options:

• Pemphigus vegetans: A variant of pemphigus vulgaris, but clinically characterized by vegetating lesions rather than flaccid bullae.
• Pemphigus vulgaris: Characterized by flaccid bullae and suprabasal acantholysis, matching the clinical and histological findings precisely.
• Pemphigus foliaceous: Typically presents with crusted lesions due to more superficial epidermal involvement, not a suprabasal split.
• Erythema multiforme: Presents with "target" lesions, not flaccid bullae.

Conclusion: The clinical presentation of fragile, easily ruptured bullae along with a suprabasal split matches pemphigus vulgaris. This autoimmune blistering disease is characterized by the presence of antibodies against desmosomes, leading to the observed features.