Pemphigus induced alopecia : a rare presentation

Pemphigus vulgaris (PV) is a rare autoimmune blistering disease characterized by mucocutaneous erosions due to autoantibodies against desmogleins. While scalp involvement is relatively common, progressive alopecia as a presenting symptom remains rare and may delay diagnosis. We report the case of an 80-year-old woman who initially presented with an erosive alopecic plaque of the scalp, evolving over three months. The diagnosis of PV was established following the appearance of bullous lesions on the trunk and limbs, supported by histology and direct immunofluorescence findings. Despite the diagnosis, the patient rapidly deteriorated due to a massive pulmonary embolism and died within 24 hours of admission. This case highlights the importance of recognizing scalp erosions with alopecia as a possible initial manifestation of PV. Awareness of this atypical presentation is essential for early diagnosis and management, potentially improving patient outcomes.