Localized Pemphigus Vulgaris on Scalp: An Atypical Presentation

This case report describes two middle-aged patients with localized pemphigus vulgaris (LPV) presenting as pruritic, crusted scalp erosions. Pemphigus vulgaris is an autoimmune blistering disease characterized by the presence of IgG autoantibodies against desmoglein 3, leading to loss of cell adhesion and blister formation. The scalp involvement as the first clinical manifestation is relatively rare, occurring in 9-15% of cases. In these patients, skin biopsies revealed epidermal acantholysis with IgG and C3 intercellular deposits, confirming the diagnosis of LPV. Treatment with low doses of oral prednisone and intralesional triamcinolone acetonide resulted in resolution of the lesions without relapse.