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S6C12P6-1: This lesion, by the distribution of the clefts along the skin surface, and in the follicles (cut in cross-section in the dermis), qualifies as pemphigus of either superficial or perhaps intermediate type. The lesion is relatively free of inflammatory cells.

S6C12P6-2: At higher magnification, a follicular cleft is well above the suprabasilar region. The site of the cleft might be characterized as superficial (i.e., pemphigus foliaceus); several layers of cells of the superficial unit are preserved along the floor of the defect. Blue arrows show a zone of reduplicated basement membrane. The spindle cells probably are fibrocytes rather than histiocytes.

S6C12P6-3: In this example of superficial pemphigus, the acantholysis is occurring in the granular layer of both the epidermis and the follicular epithelium. The superficial epidermal unit is hyperplastic.

S6C12P6-4: Jagged, acantholytic granular cells produce a striking pattern.

S6C12P6-5: The epidermis shows parakeratosis, acanthosis, elongation of rete ridges, and supra-basilar acantholysis. The acantholysis mostly involves the basal unit of the epidermis. The hyperplastic superficial unit is relatively intact; it confines the acantholytic component. Individual, acantholytic cells are rounded; they are free within the defect (“pattern of delapidated brick wall”). The follicle is relatively spared. Dermal papillae are elongated; they are covered by a single layer of basal keratinocytes. The papillary dermis is edematous. There are perivascular infiltrates of lymphocytes in the dermis (Hailey-Hailey disease ; benign familial pemphigus-like disorder [Hailey-Hailey type]).

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