Autoimmune blister disease a rarity

It looks like discoid eczema with crusts around the edges. The patient complained, not of itch, but of pain in the skin. Initially she said there were small blisters but they burst very easily leaving the crusts.

This history suggested a bullous impetigo with the blistering due to staph toxin, but she had not responded to oral antibiotics despite a skin swab growing a sensitive staphylococcus.

She had no oral blisters. A skin biopsy with immunofluorescence showed that she had the very rare immunobullous disease pemphigus foliaceus. This variant of pemphigus is less severe than pemphigus vulgaris and does not show