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The place of pemphigus vulgaris (PV) among autoimmune bullous diseases (AIBD) is well established. It is an acquired chronic, autoimmune, vesiculobullous disease in which IgG antibodies target desmosomal proteins to produce intraepithelial mucocutaneous blistering. The diagnosis is often challenging for the clinicians. It requires a combination of three major features: clinical, histopathological, and immunological. Clinically, oral lesions are the first manifestations of the disease in 50-90% of the patients with widespread blisters affecting the oral mucosa. On the skin, lesions are characterized by flaccid blisters that rapidly progress into erosions and crust formation. Umbilical lesions as a clinical manifestation of PV are peculiar and have rarely been reported, and they are not yet completely elucidated. Umbilical region involvement in patients with pemphigus was assessed in a limited study totalling just 10 patients. This localisation may be a valuable hint easing the diagnosis at the clinical level for patients with oral mucosal blisters. Dentists must be familiar with the clinical manifestations of PV to make an early diagnosis and start an early treatment which determines the prognosis of the disease. To the best of the authors' knowledge, the coexistence of these lesions with the oral lesions as a first sign of PV in the absence of skin involvement was reported in only one case of pemphigus vegetans (PVe). In this paper, we describe an observation of a female patient that was diagnosed with PV that begun with simultaneous oral and umbilical locations which coexisted for a period of 4 months before the appearance of other cutaneous lesions. We highlight the role of dentists, by being familiar with the clinical manifestations of PV, to make an early diagnosis to start an early treatment which determines the prognosis of the disease and to follow closely the evolution of lesions to change treatment if required. We also discuss the clinical, histological, and immunological features of the disease that enabled the differential diagnosis as well as the appropriate therapeutic management. [ABSTRACT FROM AUTHOR]

The article presents a 32-year-old woman with a history of fever with a generalized eruption of non-follicular pustules and erythema. Topics discussed include acute generalized exanthematous pustulosis caused by oxacillin, increased white blood cell count with neutrophilia, and appearance of lesional pattern after patch testing with oxacillin.

An obese 53-year-old male presented himself to our department with lymphedema of the left leg and ulcerated lesions evolving for two weeks prior. His medical history included epilepsy since childhood, mental retardation, chronic venous insufficiency, and chronic lymphedema complicated by recurrent ulceration and cellulitis. Over the previous four years, he had developed verrucous and papillomatous lesions on the left leg. A physical examination revealed an edematous leg with multiple painless coalescent verrucous skin-colored papules with a smooth or hyperkeratotic surface on the left lower leg surrounding the ulceration. The lesions were associated with oozing. A skin biopsy revealed hyperkeratosis, verrucoid acanthosis, and papillomatosis of the epidermis with moderate perivascular inflammatory infiltration of the dermis. A diagnosis of papillomatosis cutis lymphostatica (PCL) was reached based on histopathological and clinical findings. Our patient received lymphatic drainage and locally 5% salicylic acid. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the case of H syndrome with histological features of Langerhans cell histiocytosis.

Although very rare, squamous cell carcinoma (SCC) is the most common nail malignancy.[1] Bowen disease, or SCC I in situ, i commonly appears as a verrucous lesion of the nail bed or the nailfold, in men ranging in age from 40 to 60 years.[[1]] The diagnosis is frequently missed or delayed.[[2]] We report a case of Bowen disease of the nailfold with early dermoscopic diagnosis. GLO:DIF/01dec19:ijd14624-fig-0001.jpg PHOTO (COLOR): Bowen disease of the nailfold presenting as a localized verrucous lesion on the left thumb nail fold gl The diagnosis of Bowen disease should be considered in any recently appeared verrucous lesion of the nailfold. [Extracted from the article]