Author: Dr. Abdurrahman Almurayshid, faculty member at Prince Sattam Bin Abdulaziz University, College of Medicine, Dermatology, Saudi Arabia. June 2015.
Familial benign pemphigus, also called Hailey–Hailey disease, is a blistering disease caused by mutations in the ATP2C1 gene, with autosomal-dominant inheritance. The ATP2C1 gene is vital for keratinocyte adhesion and differentiation. Usually, the clinical presentation starts during the second or the third decade. The main affected areas are the skin folds, with moist fissured malodorous plaques and blisters. The course of the disease is variable, and treatment is mainly symptomatic.
In benign familial pemphigus, acantholysis affects the whole epidermis, giving the classic description of the dilapidated brick wall (figures 1–4). The hair follicles are usually spared, typically, with acanthosis and dyskeratosis.
Direct immunofluorescence is applied to fresh tissue to exclude an immunobullous disease, particularly pemphigus vulgaris.
Grover disease: usually more focal histologically.
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