Pemphigus Vegetans In The Scalp: A Therapeutic Challenge

Pemphigus vegetans is a rare variant of pemphigus vulgaris characterized by vegetating plaques in the flexures. A 49 – year old male patient with pemphigus vulgaris developed in the third year of his disease a hypertrophic plaque in the scalp. Lesion ́s biopsy has revealed acanthosis, papillomatosis of the epidermis and suprabasal clefts; a diagnosis consistent with Pemphigus vegetans was made. The patient was then put on shaving, mechanical debridement, clobetasol propionate and sulfamethoxazole – trimethoprim after the isolation of Staphylococcus aureus in biopsy fragment of the scalp lesion. After increasing azathioprine dose and starting with papain dressings on the long – standing lesion it was observed a slow and progressive clearing. A chronic infectious process linked to Pemphigus vegetans might explain the refractoriness to multiple therapeutic approaches. Papain has shown to be an effective and inexpensive alternative.