Pemphigus foliaceus is a blistering disorder where the blisters are very superficial. Small, rather flaccid blisters may be seen on an erythematous base but as they break quickly, the predominant clinical characteristic is the presence of erythematous, somewhat scaly patches with a collarette scale.
Clinically, the patient may appear to be erythrodermic and give the appearance of a generalized exfoliative dermatitis.
When blisters are absent, and the predominant characteristic is the scaling and hyperkeratosis, lesions on the face and elsewhere may resemble cutaneous lupus erythematosus (pemphigus erythematosus-Senear-Usher syndrome).
- Mild pemphigus foliaceus can respond very well to topical glucocorticoids such as clobetasol 0.05% cream bid to the involved areas.
- More extensive pemphigus foliaceus generally requires prednisone up to 50 mg per day. Failure to respond to prednisone suggests the use of other immunosuppressives.