AlSharhan Fahad, AlQusaimi Reem, AlAwadhi Doaa, AlRujaib Fawziah, Alebrahim Zainab, AlHashel Maryam, Alhasawi Afnan, Nasser Rawan, Alyousef Shireefa
Dermatology, Abdulkareem AlSaeed Dermatology Center, Kuwait City, KWT.
Medicine and Surgery, Jaber AlAhmad Hospital, Kuwait City, KWT.
Cureus. 2025 Jul 18;17(7):e88268. doi: 10.7759/cureus.88268. eCollection 2025 Jul.
Pemphigus foliaceus (PF) is a rare autoimmune blistering skin disease characterized by superficial erosions and crusts due to autoantibodies targeting desmoglein 1. Diagnosis can be challenging, particularly when initial presentation mimics common dermatoses such as atopic dermatitis. We report the case of a 55-year-old Syrian female initially diagnosed with severe atopic dermatitis, who presented with widespread pruritic skin lesions unresponsive to corticosteroids. Clinical deterioration with new vesiculobullous lesions prompted re-evaluation. Histopathology and serologic testing confirmed PF. The patient achieved disease control with systemic corticosteroids and immunosuppressive therapy and remains in remission after two years of follow-up. This case underscores the diagnostic complexity of PF, especially in patients with overlapping or misleading dermatologic histories. A high index of suspicion, timely biopsy, and serological confirmation are essential for diagnosis. Long-term immunosuppressive therapy combined with corticosteroids proved effective in achieving sustained remission.
落叶型天疱疮（PF）是一种罕见的自身免疫性水疱性皮肤病，其特征是由于针对桥粒芯糖蛋白1的自身抗体导致表皮糜烂和结痂。诊断可能具有挑战性，尤其是当最初表现类似于特应性皮炎等常见皮肤病时。我们报告了一例55岁的叙利亚女性病例，最初被诊断为重度特应性皮炎，她出现了广泛的瘙痒性皮肤病变，对皮质类固醇治疗无反应。新的水疱大疱性病变导致临床病情恶化，促使重新评估。组织病理学和血清学检测确诊为PF。患者通过全身皮质类固醇和免疫抑制治疗实现了疾病控制，随访两年后仍处于缓解期。该病例强调了PF的诊断复杂性，尤其是在有重叠或误导性皮肤病史的患者中。高度的怀疑指数、及时活检和血清学确诊对于诊断至关重要。长期免疫抑制治疗联合皮质类固醇被证明对实现持续缓解有效。
