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Isolated erythematous plaque on the right cheek
Ting-Shun Wang, Tsen-Fang Tsai

A 54-year-old man without underlying disease had one mild itchy rash on the right cheek for 6 months. He tried topical fluocinolone acetonide ointment and the lesion became less itchy. However, the rash enlarged gradually, so he came to our clinic. Cutaneous finding was a 4 × 5 cm, erythematous-to-brownish plaque on the right cheek with focal erosions. No lesions were found elsewhere (Figure 1A). A skin biopsy was done, which revealed acantholytic cells mainly in the granular layer and nonspecific perivascular and perifollicular infiltration in the dermis (Figure 1B). Focal hydropic changes and pigment incontinence were also present. Direct immunofluorescence (DIF) showed positive immunoglobulin (Ig) G deposition at the intercellular space and along the basement membrane zone (BMZ; Figure 1C). Indirect immunofluorescence (IIF) showed anti-intercellular space antibody 1:80 (+). Antinuclear antibody (ANA)was 1:40(−) and antiextractable nuclear antigen (ENA) antibodies were all negative. He was treated with oral prednisolone 50 mg daily by tapering dose during the following 5 months; the lesion improved gradually (Figure 1D).

Pemphigus erythematosus (PE).

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