Familial benign chronic pemphigus of perianal skin

Papular acantholytic dyskeratosis of the anogenital and genitocrural area: case series and review of the literature

BACKGROUND

Papular acantholytic dyskeratosis (PAD) of the anogenital/genitocrural area is described as a rare distinct clinicopathological entity known to dermatopathologists, although its characteristic histopathologic pattern resembles both Hailey-Hailey disease and Darier disease. The objective of this study is to describe the clinical characteristics, histopathologic features and response to treatment of PAD.

METHODS

We report in detail six cases of PAD. A literature search of the keyword 'papular acantholytic dyskeratosis' was performed on Google scholar and PubMed, 21 cases of this entity were found. A total of 27 patients including our six cases are reviewed in this study.

RESULTS

The mean age at diagnosis was 38.8 years with a male to female ratio of 0.8 : 1. Clinically, papular lesions (55.6%) are the typical manifestation of PAD, and the anogenital area (63%) is the most commonly involved site. Lesions were resistant to topical steroids, subcutaneous interferon and antibiotics while one case showed complete resolution of the lesions after retinoid therapy. Laser therapy showed good results in one case. None of the patients had spontaneous remission.

CONCLUSION

Awareness of the clinicopathological hallmarks herein may be important to avoid underdiagnosis of PAD and may contribute to understanding the pathogenesis of this rare disease.

Transient acantholytic dermatosis (Grover's disease): a global perspective

Twenty-six years have passed since Grover first described transient acantholytic dermatosis. Since then, the concept of Grover's disease has been expanded to include persistent acantholytic dermatoses as well. Although its origin remains unknown, it may result from an isomorphic response to excessive heat, sweating, or xerosis. It is currently classified as a nonfamilial, non-immune-mediated, acantholytic disorder.

Acantholytic dermatosis localized to genitalia and crural areas of male patients: a report of three cases

A series of 3 cases of acantholytic dermatosis localized to the male genitalia and perineal area with distinct clinical and histological features is presented. These patients did not have a family history of similar disorders and had no evidence of rash elsewhere. Clinically, the eruption was characterized by multiple discrete papules or macerated patches involving the genitalia and the perineum. Histologically, the acantholytic dermatosis had features that resembled both Hailey-Hailey disease and Darier's disease. Similar clinical and histological findings have been reported in females. To the best of our knowledge, this is the first report of these lesions described confined to the genital and perineal areas in male patients. We agree with other authors that this condition may represent a distinct acantholytic eruption in the perineal area that should be distinguished from other generalized blistering acantholytic dyskeratotic disorders that may also involve the genitalia.

Histologic findings of Hailey-Hailey disease in a patient with bullous pemphigoid

The association of bullous pemphigoid with other immune-mediated diseases has been described; however, coexistence with other bullous dermatoses is unusual. We describe a patient with longstanding localized bullous pemphigoid and the recent finding of a Hailey-Hailey-like histologic pattern in a biopsy specimen obtained at a site of active pemphigoid involvement, as confirmed by immunofluorescence studies. Although this case suggests the possibility of coexistence of two bullous diseases, the Hailey-Hailey-like pattern more likely represents an incidental microscopic finding or a solitary acantholytic lesion.

Acantholytic dermatosis localized to the vulvocrural area

This report describes 6 women with acantholytic lesions localized to the vulvocrural area. Clinically, multiple papules or solitary papules or plaques were situated on the labia majora or adjacent skin. None of the patients had similar abnormalities elsewhere on the body or family histories of similar eruptions. Two patients had concurrent candidal vaginitis. Microscopic findings consisted of acantholytic dyskeratosis resembling that observed in Darier's disease or acantholysis with minimal dyskeratosis similar to that seen in Hailey-Hailey disease. In one patient, acantholytic dyskeratosis with a cup-like configuration resembled the microscopic appearance of warty dyskeratoma. Immunofluorescence microscopy was negative in one patient. Solitary lesions were cured by local excision, but the papular eruption of one patient was recalcitrant to therapy. The literature contains descriptions of eight additional women with comparable lesions. Acantholytic reactions localized to the vulvocrural area are not apparently rare and need to be distinguished from other acantholytic dermatoses that can affect this anatomic site.

Chronic benign familial pemphigus

Ten patients with benign familial chronic pemphigus (BFCP) (Hailey-Hailey disease) were evaluated; semiologic and localization differences were described, and special attention was given to solitary or atypical forms. In all the cases, the diagnosis was confirmed by histopathology; some histopathologic differences and the results achieved by direct immunofluorescence of skin are discussed. Most of the patients responded to the treatment with corticosteroids and antibiotics.