Image in medicine
A 4-year-old child presented with multiple hyperpigmented and hypopigmented macules and plaques over both forearms, with a history of recurrent flaccid bullae and erosions at the same sites. Nikolsky sign was positive during the active phase. Tzanck smear showed acantholytic cells, and skin biopsy revealed intraepidermal acantholysis.
Direct immunofluorescence demonstrated intercellular deposition of IgG and C3 in a fish-net pattern, confirming the diagnosis. The child was treated with systemic corticosteroids and azathioprine, leading to disease control. The present image shows the healing phase with post-inflammatory dyspigmentation and residual scarring, highlighting chronic sequelae of pediatric pemphigus vulgaris, a rare condition in this age group.