Transient acantholytic dermatosis mimicking pemphigus foliaceus: a report of 2 cases

Abstract

Transient acantholytic dermatosis (TAD) is a relatively uncommon acquired acantholytic disorder of unknown etiology, typically characterized by pruritic papulovesicular eruptions predominantly affecting the trunk, however atypical presentations can occur and pose diagnostic challenges, as illustrated in this report of two female patients aged 29 and 50 years who presented with rapidly evolving vesiculobullous lesions that ruptured to form erosions and extensive crusted plaques involving the scalp, face, neck, and trunk, thereby closely mimicking pemphigus foliaceus, while routine laboratory investigations including complete hemogram, serum biochemistry, thyroid profile, lipid profile, viral markers, and serum electrophoresis were within normal limits, histopathological examination revealed features of acantholysis with subcorneal blister formation in one case and suprabasal clefting in the other along with hyperkeratosis and mild dermal inflammatory infiltrate, and direct immunofluorescence studies were negative effectively ruling out autoimmune blistering disorders, based on detailed clinical evaluation and clinicopathological correlation a diagnosis of TAD was established, following which both patients were managed with parenteral corticosteroids, systemic antibiotics, saline soaks, and supportive care leading to near-complete resolution of lesions within a short duration, thus these cases highlight an unusual presentation of TAD with predominant head and neck involvement that can closely resemble pemphigus foliaceus, emphasizing that a high index of suspicion along with appropriate use of histopathology and immunofluorescence is essential for accurate diagnosis, differentiation from other acantholytic disorders, and timely institution of effective management while avoiding misdiagnosis and unnecessary prolonged therapy.