Pemphigus Vegetans

Pemphigus vegetans is considerably less common in the mouth than pemphigus vulgaris [15]. It usually presents clinically as serpiginous ulcers that are most frequent on the dorsum of the tongue and lips [187]. The lingual lesions closely resemble those of erythema migrans. The papillomatous, proliferative lesions that characterise cutaneous pemphigus vegetans can sometimes be seen at the angles of the mouth. As in pemphigus vulgaris, drugs, particularly ACE inhibitors, have been invoked as possible causative agents in some cases [12, 137].

Microscopically, the epithelium tends to proliferate and become verruciform. Acantholytic cells may not be conspicuous and eosinophil microabscesses are said to be the most typical histological feature. However, the lesions frequently resemble pyostomatitis vegetans and conventional microscopy may not be diagnostic. The presence of typical skin lesions often helps in making the diagnosis and it may be differentiated from pyosto-matitis by the clinical picture and appropriate immuno-cytochemical investigations [73].

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