Pemphigus foliaceus with osteoporosis in a-64-year-old woman

Introduction: Pemphigus foliaseus (PF) is a group of autoimmune blistering disease with blisters on the stratum granulosum or at the base of stratum corneum. PF is commonly found in women with an average age 40-60 years. Clinical symptoms of PF are erosions, crusts, scales, with an erythematous base and located in seborrheic areas. Primary PF lesions, flaccid blisters, are usually difficult to find. Systemic corticosteroids, usually oral prednisone, are standard treatments with an initial dose 60 mg daily. Osteoporosis, derived from the word osteo which means bone and porosis means thinning or becoming porotic. Pharmacologic treatment of osteoporosis includes calcium supplements, vitamin D, and anti-resorbsi medications such as estrogen, calcitonin and bisphosphonates.

Case: A 64-year-old female patient with preexisting crusts and scales increasing in quantities and also blisters on all over the body since a month ago. Flaccid blisters were found on extremities. Histopathology revealed PF. Radiologic examination of thoracolumbar supported osteoporosis and thoracolumbar spondylosis. Treatment with prednisone tablets 60 mg daily, and Risedronate tablets 5 mg daily made clinical improvement.

Discussion: This was the first case report of PF with osteoporosis in Dr. Mohammad Hoesin General Hospital Palembang Indonesia. The diagnosis of PF with osteoporosis was based on history taking, physical examination, histopathological features and radiologic examination. Treatment was oral and topical corticosteroid for PF and oral biphosphonate for osteoporosis. Combination of treatment made clinical improvement.