Locations of acantholysis in pemphigus vulgaris and pemphigus foliaceus

BackgroundAcantholysis in pemphigus vulgaris (PV) and pemphigus foliaceus (PF) occurs predominantly in the suprabasal area and the granular layer, respectively. However, acantholysis can occasionally be observed in unusual locations. MethodsWe retrospectively studied the acantholysis locations in 35 PV and 27 PF cases, and analyzed them using the index value of Desmoglein (Dsg) 1 and Dsg3 by enzyme-linked immunosorbent assay, clinical data, and inflammatory cells. We also analyzed the relationship between clinical subtype and various parameters. ResultsIn PV, acantholysis was noted in the suprabasal area in 3 cases, in the lower half of the epidermis in 19 cases, and throughout the epidermis in 13 cases. In PF, acantholysis was observed in the granular layer in 6 cases, in the upper half of the epidermis in 14 cases, and throughout the epidermis in 7 cases. Mean index value of Dsg1 in PV patients with acantholysis throughout the epidermis was 2-fold higher than other PV patients. Neutrophils tended to infiltrate the dermis and epidermis more in PF than in PV. ConclusionsHigher Dsg1 index values seem to correlate with acantholysis in the upper part of the epidermis in PV. Neutrophils may play some role in unusual acantholysis locations in PF.