Pemphigoid vegetans.

A 24-year-old woman had massive purulent and verrucous vegetations with fissuring in the groin and axillae. She also had scaling, crusted, bullous, and purulent lesions on the scalp, face, axillae, umbilicus, groin, and hands. Biopsy specimens of skin for histopathologic examinations and direct immunofluorescent study showed typical bullous pemphigoid, and serial serum samples tested by indirect immunofluorescent study confirmed the diagnosis. A basement membrane antibody was presented on four occasions at titers of 320, 1,280, 169, and 320. The differential diagnosis included dermatitis vegetans and pemphigus vegetans. An appropriate term for this manifestation of bullous pemphigoid is "pemphigoid vegetans."