# Unusual Presentation of Pemphigus Vulgaris as a Solitary Ulcerative Scalp Lesion: A Case Report

## TL;DR

A rare case of pemphigus vulgaris presented as a single scalp ulcer, leading to a delayed diagnosis and highlighting the need to consider autoimmune diseases in similar cases.

## Contribution

Reports a unique presentation of pemphigus vulgaris as a solitary scalp lesion, expanding its clinical recognition.

## Key findings

- The patient presented with a chronic, non-healing scalp lesion initially misdiagnosed as infectious or neoplastic.
- Diagnosis of pemphigus vulgaris was confirmed only after the development of oral ulcers and immunofluorescence studies.
- Treatment with corticosteroids and mycophenolate mofetil led to significant clinical improvement.

## Abstract

Pemphigus vulgaris (PV) is a rare autoimmune blistering disease that typically presents with painful oral erosions followed by widespread cutaneous involvement. We report a diagnostically challenging case of PV in a 43-year-old man who initially presented with a solitary, ulcerative-crusted lesion on the parietal scalp, evolving over eight months. The lesion was clinically suggestive of infectious or neoplastic etiologies, including tinea capitis, squamous cell carcinoma, Bowen's disease, and leishmaniasis. Empirical antifungal treatment was ineffective, and mycological studies were negative. Dermoscopy revealed yellow crusts, serpentine vessels, and perifollicular whitish halos. The patient later developed painful oral ulcers, which led to histopathological and immunofluorescence studies confirming PV. Systemic corticosteroids and mycophenolate mofetil were initiated with marked clinical improvement. This case highlights an uncommon presentation of PV that delayed diagnosis and emphasizes the importance of considering autoimmune bullous disorders in the differential diagnosis of chronic, non-healing scalp lesions, even in the absence of mucosal involvement.