Pemphigus vegetans with paronychia-like changes resistant to rituximab therapy.

Pemphigus vegetans is a clinical variant of pemphigus vulgaris that makes up about 2% of all cases. It is distinguished from pemphigus vulgaris by the presence of vegetative plaques that are usually found in the oral mucosa or intertriginous areas. Pemphigus vegetans can present as one of two clinical subtypes: Hallopeau type and Neumann type. The Hallopeau type is a milder form of the disease, often sparing the oral mucosa. The Neumann type is a more severe form that often includes oral mucosal involvement. Nail unit disease of pemphigus vegetans is rare, lending to limited recommendations for management. Herein we present a case of PVeg with paronychia-like changes following rituximab therapy, along with a brief review of PVeg nail unit disease management. Previously reported treatments include prednisone, azathioprine, dapsone and cyclosporine. In this patient with nail disease despite rituximab therapy, intralesional triamcinolone acetonide was effective, thereby avoiding the need for additional immunosuppression. This article is protected by copyright. All rights reserved.