A case of pemphigus foliaceus induced by diphenylhydantoin

As opposed to most other drug eruptions, drug-induced pemphigus may not develop for at least several months following the initiation of therapy with the offending agent. Unlike sporadically occuring pemphigus, the clinical and histopathologic patterns of drug-induced pemphigus are most often those of pemphigus foliaceus. We report a case of diphenylhydantoin-induced pemphigus occuring in 30-year-old male with epilepsy. A few coin-sized erythematous scaly patches developed on his face, chest, and left wrist, and two flaccid bullae on erythematous base developed on his abdomen after three years and nine months of therapy with diphenylhydantoin. Histopathologically, a biopsy specimen taken from a bullous lesion revealed that bulla is formed just beneath the granular layer and acantholytic cells are seen within the bulla. Direct and indirect immunofluorescence studies showed negative findings. Administration of diphenylhydantoin was discontinued and he was treated with systemic and topical corticosteroid. After 4 weeks, the skin lesions were healed with postinflammatory hyperpigmentation and no new lesions were developed thereafter.