Persistent facial rash

We present the case of a 91-year-old woman who was referred for evaluation of a unilateral, painful rash over the right periorbital area, cheek and neck. There was no mucosal involvement. She had previously been treated empirically for multidermatomal herpes zoster. Skin histology revealed suprabasal acantholysis, and enzyme-linked immunosorbent assays confirmed a high anti-desmoglein 3 antibody titre and a normal anti-desmoglein 1 antibody titre.